Oral paricalcitol for the treatment of secondary hyperparathyroidism in hemodialysis patients

SummaryBackgroundSecondary hyperparathyroidism is common amongst dialysis patients and is associated with increased morbidity and mortality. Vitamin D analogues are effective treatments, but the adverse effects of traditional vitamin D preparations, especially hypercalcemia, are often dose-limiting.PurposeWe studied the efficacy and safety of paricalcitol for the treatment of secondary hyperparathyroidism in hemodialysis patients.MethodsWe reviewed 13 adult hemodialysis patients treated with oral paricalcitol. The dosage of paricalcitol was adjusted according to the clinical response.ResultsSerum parathyroid hormone (PTH) level decreased by 47.3 ± 34.3% at 3 months and 74.7 ± 36.8 % by 3 years. Eight patients (62%) responded and had reduction in PTH levels by at least 30%; seven of them (87.5%) responded within the first 3 months. Responders had a significantly lower baseline PTH level than the nonresponders (64.3 ± 32.2 vs. 138.5 ± 64.0 pmol/L, p = 0.02). None of the patients developed hypercalcemia, but hyperphosphatemia was present in all patients.ConclusionThere is a substantial improvement in PTH levels by paricalcitol treatment in hemodialysis patients with secondary hyperparathyroidism, and paricalcitol is generally well tolerated. Our results suggest that patients with more advanced secondary hyperparathyroidism tend to have a less favorable response.

背景在血液透析患者間，次發性甲狀旁腺功能亢進是常見的疾病，會明顯增加患者的死亡與患病率。維生素 D 類似物通常是有效的療法，但傳統製劑的臨床應用常受限於不良作用如高鈣血症的出現。本研究以患有次發性甲狀旁腺功能亢進的血液透析患者為對象，調查了 paricalcitol 在這方面的功效與安全性。方法本研究回顧了 13 位成年血液透析患者，正在接受口服 paricalcitol 治療，其劑量根據臨床反應作出調整。結果經過 3 個月及 3 年後，血清副甲狀腺素 (PTH) 水平分別下降 47.3 ± 34.3% 及 74.7 ± 36.8%。其中，8 人 (62%) 反應良好，PTH 降幅達至少 30%；他們之中有 7 人 (87.5%) 在首 3 個月呈現反應。相比於不反應者，反應者的基線 PTH 明顯較低 (64.3 ± 32.2 vs 138.5 ± 64.0 pmol/L，p = 0.02)。治療期間，無任何人出現高鈣血症，但所有病人均有高磷酸血症的現象。結論對於患有次發性甲狀旁腺功能亢進的血液透析患者，paricalcitol 可有效降低 PTH，且耐受性良好。本研究的結果亦顯示，較晚期的次發性甲狀旁腺功能亢進患者，其療效反應可能較為不明顯。