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Efficacy of Intravenous Vitamin-D Selective Receptor Activator (Paricalcitol) In Management of Secondary Hyperparathyroidism in Hemodialysis Patients, Single Center Experience

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Last updated: 03 Jan 2025

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Abstract

Background: secondary hyperparathyroidism (SHPT), a complication of chronic kidney disease (CKD) and is characterized by not only increased serum levels of intact parathyroid hormone (iPTH), but also may cause skeletal and cardiovascular complications. Deficiency of calcitriol (1, 25-hydroxy vitamin D) caused by impaired renal function, a main factor in the pathogenesis and pathophysiology of secondary hyperparathyroidism (SHPT) is associated with poor outcomes in hemodialysis patients.  Therapy with vitamin D receptor (VDR) activators, including calcitriol or the selective VDR activator paricalcitol, has been associated with improved survival in patients with CKD on hemodialysis. PATIENTS AND METHODS: single center cross over observational study of 28 patients on regular Hemodialysis in nephrology unit in Dubai hospital, the patient stopped all vitamin-D supplementations and calcium containing phosphate binder for 2 weeks prior to initiation and for the whole study period, non calcium based phosphate binder was continued. Initial dose of selective VDRA (PARICALCITOL)  is 0.04 to 0.1 mcg/kg body weight (average total dose 2.8 – 7 mcg) administered as a bolus dose  post hemodialysis twice to three times per week according to initial parathyroid hormone level Titration weekly  dose (micrograms) calculated by dividing  most recent i-PTH level (pg/ml)/80. RESULTS : analyzing the data at start and end of trial period 48 weeks showed that there was significant reduction of  serum I-PTH from (491.210±144.690 pg/dl ) at start of the trial  to (142.610    ±41.519pg/dl) at 48 weeks  with P- value (<0.001) . Serum calcium increased from ( 8.343± 0.654mg/dl ) at the start of the study to (8.629±0.534mg/dl ) at 48 weeks but without statistical significance P- value (0.006), same occurred with serum phosphatewhich showed insignificant  rise with phosphate level at start of the test( 7.264±1.695mg/dl) and at 48 weeks (7.279±1.800mg/dl) with P-value( 0.975). CONCLUSION: It could be concluded that use of intravenous vitamin D selective receptor activator (Paricalcitol) is effective in reducing serum I-PTH level in hemodialysis patients. Serum Ca++ and phosphorus levels were statistically insignificant.  

DOI

10.12816/0018756

Keywords

Paricalcitol, vitamin D selective receptor activator, secondary hyperparathyroidism, Hemodialysis

Authors

First Name

Ayman Aly

Last Name

Seddik

MiddleName

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Affiliation

Department of Medicine, Faculty of Medicine Ain Shams University, Cairo, Egypt and Nephrology Department, Dubai Hospital, Dubai Health Authority.

Email

seddik500@gmail.com

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Volume

61

Article Issue

1

Related Issue

3110

Issue Date

2015-10-01

Receive Date

2018-09-26

Publish Date

2015-10-01

Page Start

522

Page End

528

Print ISSN

1687-2002

Online ISSN

2090-7125

Link

https://ejhm.journals.ekb.eg/article_14879.html

Detail API

https://ejhm.journals.ekb.eg/service?article_code=14879

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17

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Original Article

Type Code

606

Publication Type

Journal

Publication Title

The Egyptian Journal of Hospital Medicine

Publication Link

https://ejhm.journals.ekb.eg/

MainTitle

Efficacy of Intravenous Vitamin-D Selective Receptor Activator (Paricalcitol) In Management of Secondary Hyperparathyroidism in Hemodialysis Patients, Single Center Experience

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Article

Created At

22 Jan 2023