Background: Secondary hyperparathyroidism remains a serious problem in hemodialysis patients. The therapy of renal osteodystrophy is mainly based on lowering phosphate levels and administering vitamin D(3) metabolites and calcimimetic agents.
Methods: An observational, prospective, multicenter study was made to evaluate the efficacy of alfacalcidol in 185 chronic hemodialysis patients with secondary hyperparathyroidism (i-PTH >150 pg/ml). Patients with a CaxP product >70 were excluded. Intermittent therapy with intravenous alfacalcidol was observed for 6 months.
Results: The mean dose of alfacalcidol per week was 3.63 +/- 1.71 microg. Patients previously treated with vitamin D(3) metabolites needed higher doses of alfacalcidol (4.0 +/- 1.7 vs. 3.2 +/- 1.6; p = 0.01). Only 50.8% of the patients had received vitamin D(3) metabolites prior to the start of the study and at baseline they had higher i-PTH levels (600.3 +/- 360.5 vs. 489.9 +/- 292.6, p = 0.02). i-PTH levels decreased from 546 +/- 332.6 to 332.4 +/- 274.5 pg/ml (p < 0.001). 60.5% of the patients had i-PTH < 300 pg/ml at the last observation. Serum calcium increased (9.4 +/- 0.8 to 9.97 +/- 1.0 mg/l, p < 0.001).
Conclusion: Alfacalcidol reduced the levels of i-PTH and produced a slight increase in serum calcium and phosphate levels. In mild or moderate hyperparathyroidism the doses needed were lower than in severe hyperparathyroidism.
(c) 2008 S. Karger AG, Basel