Document Detail


Severe hyperparathyroidism despite paricalcitol therapy: one-year follow-up.
MedLine Citation:
PMID:  14763069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Paricalcitol [Zemplar: Abbott Laboratories, Abbott Park, IL, U.S.A.] is efficient for treating secondary hyperparathyroidism in patients on maintenance hemodialysis (HD). Zemplar is thought to be more potent than calcitriol and has been reported to cause less hypercalcemia and hyperphosphatemia. Here, we report a 1-year follow-up on patients from one inner-city dialysis unit. We reviewed the charts of 100 patients and collected data for 1 year. Patients were stratified into four groups depending upon their intact parathormone (iPTH) levels. Hemoglobin (Hb) and erythropoietin (EPO) doses were determined. More than 50% of patients had iPTH levels greater than 300 pg/mL. Mean Ca and PO4 levels were not significantly different, but Zemplar doses were significantly different in all groups. None of the patients had symptomatic bone disease. Seven patients were changed to low-Ca dialysate (1.0 mEq/L) secondary to hypercalcemia (Ca > 11.5 mg/dL) and severe secondary hyperparathyroidism. Interestingly, patients with low iPTH (< 100 pg/microL) showed relative EPO resistance, and patients with high iPTH (> 600 pg/microL) required smaller EPO doses. An inverse relationship was observed between Zemplar and EPO dose. The effect of Zemplar on EPO responsiveness needs to be confirmed in a larger study. Our data suggest that severe secondary hyperparathyroidism is frequent despite aggressive paricalcitol therapy in our inner-city HD population. To control severe secondary hyperparathyroidism in these patients, dietary and medication compliance may need to be supplemented with more effective non-calcium phosphate binders or calcimimetic agents, or both.
Authors:
Suhail B Shuja; Rasib M Raja
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis     Volume:  19     ISSN:  1197-8554     ISO Abbreviation:  Adv Perit Dial     Publication Date:  2003  
Date Detail:
Created Date:  2004-02-06     Completed Date:  2004-02-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9104803     Medline TA:  Adv Perit Dial     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  231-5     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Calcium / blood
Ergocalciferols / therapeutic use*
Erythropoietin / administration & dosage
Hemoglobins / analysis
Humans
Hyperparathyroidism, Secondary / blood,  drug therapy*,  etiology
Kidney Failure, Chronic / complications,  therapy
Middle Aged
Parathyroid Hormone / blood
Renal Dialysis*
Chemical
Reg. No./Substance:
0/Ergocalciferols; 0/Hemoglobins; 0/Parathyroid Hormone; 11096-26-7/Erythropoietin; 131918-61-1/paricalcitol; 7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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