Effect Of Calcitriol Therapy In Uremia With Secondary Hyperparathyroidism

Purpose: Life span of uremia patients has remarkably extended accompanied by the increasingly improved hemodialysis technology.Hemodialysis contributes to solving some problems of renal failure;however,the sustained hypocalcaemia and hyperphosphatemia have resulted in annually increased morbidity of secondary hyperparathyroidism(SHPT).Decrease in 1,25-(OH)2D3 accounts for an important cause of SHPT,which is mostly treated with low maintenance dose of calcitriol supplement.It can partly improve clinical symptoms in CRF patients,but shows no marked effects on improving hyperphosphatemia,hypocalcaemia and high PTH.As a result,some patients have to undergo parathyroidectomy eventually.Pulse therapy with large dose of calcitriol promotes the uptake of 1,25-(OH)2D3 by parathyroid,which can thereby suppress proliferation of parathyroid cell,improve hyperphosphatemia and hypocalcaemia of SHPT,reduce serum intact parathyroid hormone(i PTH)and notably improve clinical symptoms.105 uremia patients with SHPT were selected from our hospital in this research,60 of them received pulse therapy with large dose of calcitriol,while 45 underwent basic supplement therapy.Therapeutic effects and safety between two groups were compared,analyzed and evaluated comprehensively.Method: 105 patients with SHPT receiving over 1 year of regular hemodialysis in our hospital from January 2008 to December 2014 were selected,including 53 male cases and 52 female cases.Serum i PTH level was between 500 and 1000pg/ml,serum calcium(Ca2+)level was lower than 2.5mmol/L;serum phosphorus(P3+)level was lower than 2.2mmol/L,and calcium-phosphorus product(Ca×P)was lower than 55mg2/dl2 before treatment.All patients received regular dialysis for 4h each time for 3 times per week.Patients were divided on this basis into group I(n=45,conventional dose of calcitriol group)and group II(n=60,pulse therapy with calcitriol group).Group I was composed of 25 female and 20 male cases,with the average age of(64.32±12.47)years;and all patients were given oral administration of calcitriol at a dose of 0.25-0.5ug once daily before sleep.Group II was comprised of 27 female and 33 male cases,with the average age of(61.43±28.56)years,and patients were given calcitriol at a dose of 2-4ug for three times a week for 12 consecutive weeks before sleep on the day of dialysis.Differences in serum calcium(Ca),phosphorus(P),i PTH,alkaline phosphatase(AKP),hemoglobin(Hb)and hematocrit(HCT)levels between two groups were observed.Short-form 36(SF-36)Health-related Quality of Life Scale was adopted to evaluate quality of life of patients.Meanwhile,changes in symptoms such as ostealgia and itching,together with adverse reactions in both groups before and after treatment were observed.Results: HCT and Hb levels in both groups were higher after treatment than before,with difference being of statistical significance(P<0.05),but those were remarkably higher in group II after treatment than group I(P<0.05).Serum AKP in group I was slightly lower after treatment than before,but difference was not statistically significant(P=0.213);that in group II after pulse therapy was significantly lower than before treatment,with difference being statistically significant(P<0.05).Serum calcium level in group I showed no obvious change before and after treatment(P>0.05);that in group II was slightly higher after treatment than before,but difference was not statistically significant(P>0.05).Serum phosphorus levels in both groups were slightly lower after treatment,but differences were not statistically significant(P>0.05).i PTH level in group I was slightly lower after treatment than before,but difference was not statistically significant(P>0.05);that in group II after pulse therapy was notably lower than before treatment,with difference being of statistical significance(P<0.001).SF-36 scores in both groups after treatment were improved compared with those before treatment,with improving effects in pulse therapy group being more distinct(P<0.05).No severe adverse reaction was seen in both groups after treatment.5 cases in group I were transferred to pulse therapy as a result of continuously elevated i PTH,and another 3 underwent parathyroidectomy.2 cases in group II developed hypercalcemia during pulse therapy and another 1 had hyperphosphatemia,but no case required parathyroidectomy.Conclusion: Compared with basic therapy,pulse therapy with calcitriol has marked effects on improving symptoms of hyperparathyroidism secondary to uremia,reducing serum i PTH and AKP,as well as elevating Hb and HCT.It greatly lowers the probability for patients with hyperparathyroidism secondary to uremia to undergo surgery and is associated with excellent clinical effects.