Intermittent calcitriol therapy in secondary hyperparathyroidism: A comparison between oral and intraperitoneal administration

• Published in: Kidney international Vol. 54; no. 3; pp. 907 - 914
• Main Authors: Salusky, Isidro B., Kuizon, Beatriz D., Belin, Thomas R., Ramirez, Jorge A., Gales, Barbara, Segre, Gino V., Goodman, William G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1998; Nature Publishing
• Subjects: Administration, Oral; Adolescent; Biological and medical sciences; Bone and Bones - pathology; bone histology; Calcitriol - administration & dosage; Calcium - blood; Child; dialyzed children; end-stage renal disease; Female; Humans; Hyperparathyroidism, Secondary - blood; Hyperparathyroidism, Secondary - drug therapy; Hyperparathyroidism, Secondary - pathology; Injections, Intraperitoneal; Male; Medical sciences; mineral metabolism; parathyroid hormone; peritoneal dialysis; Pharmacology. Drug treatments; Phosphorus - blood; Prospective Studies; skeletal lesion; Urinary system; parathyroid hormone; dialyzed children; mineral metabolism; peritoneal dialysis; skeletal lesion; bone histology; end-stage renal disease; Endocrinopathy; Human; Kidney disease; Urinary system disease; Hemodialysis; Calcitriol; Phosphorus; Metabolism; Route of administration; Extrarenal dialysis; Chemotherapy; Chronic; Treatment; Vitamin D; Parathyroid diseases; Renal failure; Complication; Child; Comparative study; Hyperparathyroidism
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.1998.00045.x

Intermittent calcitriol therapy in secondary hyperparathyroidism: A comparison between oral and intraperitoneal administration. Intermittent oral or intravenous doses of calcitriol given two or three times per week are commonly used to treat secondary hyperparathyroidism (2° HPT). This study was undertaken to compare the biochemical and skeletal responses to thrice weekly intraperitoneal (i.p.) versus oral doses of calcitriol in children with 2° HPT undergoing peritoneal dialysis (CCPD). Forty-six patients aged 12.5 ± 4.8years on CCPD for 22 ± 25months were randomly assigned to treatment with oral (p.o.) or i.p. calcitriol for 12months; 17 subjects given p.o. calcitriol and 16 subjects given i.p. calcitriol completed the study. Bone biopsies were performed at the beginning and at the end of the study, while determinations of serum and total ionized calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH) and calcitriol levels were done monthly. Serum total and ionized calcium levels were higher in subjects treated with i.p. calcitriol, P < 0.0001, whereas serum phosphorus levels were higher in those given p.o. calcitriol, P < 0.0001. For the i.p. group, serum PTH levels decreased from pre-treatment values of 648 ± 125pg/ml to a nadir of 169 ± 57pg/ml after nine months. In contrast, serum PTH levels did not change from baseline values of 670 ± 97pg/ml in subjects given p.o. calcitriol, P < 0.0001 by multiple regression analysis. Serum alkaline phosphatase levels were also lower in patients treated with i.p. calcitriol, P < 0.0001, but there was no difference between groups in the average dose of calcitriol given thrice weekly. The skeletal lesions of 2° HPT improved in both groups, 33% of patients developed adynamic bone lesion. Differences in the bioavailability of calcitriol and/or in phosphorus metabolism may account for the divergent biochemical response to p.o. and i.p. calcitriol.