Comparison of the efficacy of an oral calcitriol pulse or intravenous 22-oxacalcitriol therapies in chronic hemodialysis patients
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
1,25-dihydroxy-22-ovavitamin D3 (22-oxacalcitriol, OCT) was recently introduced commercially as an analogue of 1,25 (OH)2 vitamin D3, but one which has less pronounced calcemic activity.
To examine the efficacy and tolerability of OCT, 46 hemodialysis patients with secondary hyperparathyroidism were randomly assigned to receive either intravenous OCT or oral calcitriol pulse therapies. The patients were monitored for serum calcium, phosphate, intact parathyroid hormone (PTH), and bone alkaline phosphatase (BAP) for 24 weeks. The efficacy of intravenous OCT was also examined in 24 additional patients who were refractory to oral calcitriol pulse therapy.
In the randomized trial, intact PTH levels were significantly suppressed within 4 weeks after the initiation of each therapy, and this effect was well maintained thereafter in both treatment groups. While intact PTH was significantly lower at 4 weeks in the calcitriol pulse group than in the OCT group (P = 0.02), no statistical differences were observed during later treatment periods. BAP was reduced equally by each treatment. At 4 weeks (P = 0.02) and thereafter (P = 0.06), serum calcium was higher among calcitriol-treated patients than among those who received OCT treatment. Eight of 24 patients who were refractory to oral calcitriol pulse therapy responded to intravenous OCT. The patients who responded tended to have lower serum intact PTH and phosphorus levels and smaller parathyroid glands at the start of OCT treatment than nonresponders.
OCT is as effective as oral calcitriol pulse therapy in suppressing intact PTH and BAP in chronic hemodialysis patients. It was confirmed that OCT exhibits less calcemic activity than calcitriol. Moreover, under certain conditions, switching to OCT may help in the treatment of hyperparathyroidism, which is refractory to conventional oral calcitriol pulse therapy.
- Hruska, KA, Teitelbaum, SL (1995) Renal osteodystrophy. N Engl J Med 333: pp. 166-74 CrossRef
- Slatopolsky, E, Weerts, C, Thielan, J (1984) Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25-dihydroxycholecalciferol in uremic patients. J Clin Invest 74: pp. 2136-43
- Tsukamoto, Y, Nomura, M, Takahashi, Y (1991) The “oral 1,25-dihydroxyvitamin D3 pulse therapy” in hemodialysis patients with severe secondary hyperparathyroidism. Nephron 57: pp. 23-8
- Quarles, LD, Yohay, DA, Carroll, BA (1994) Prospective trial of pulse oral versus intravenous calcitriol treatment of hyperparathyroidism in ESRD. Kidney Int 45: pp. 1710-21
- Levine, BS, Song, M (1996) Pharmacokinetics and efficacy of pulse oral versus intravenous calcitriol in hemodialysis patients. J Am Soc Nephrol 7: pp. 488-96
- Bacchini, G, Fabrizi, F, Pontoriero, G (1997) “Pulse oral” versus intravenous calcitriol therapy in chronic hemodialysis patients. Nephron 77: pp. 267-72
- Brown, AJ, Ritter, CR, Finch, JL (1989) The noncalcemic analogue of vitamin D, 22-oxacalcitol, suppresses parathyroid hormone synthesis and secretion. J Clin Invest 84: pp. 728-32
- Kubrusly, M, Gagne, ER, Urena, P (1993) Effect of 22-oxa-calcitriol on calcium metabolism in rats with severe secondary hyperparathyroidism. Kidney Int 44: pp. 551-6
- Tsukamoto, Y, Hanaoka, M, Matsuo, T (2000) Effect of 22-oxacalcitriol on bone histology of hemodialyzed patients with severe secondary hyperparathyroidism. Am J Kidney Dis 35: pp. 458-64
- Akizawa, T, Suzuki, M, Akiba, T (2001) Clinical effects of Maxacalcitol on secondary hyperparathyroidism of uremic patients. Am J Kidney Dis 38: pp. S147-S151
- Shigematsu, T, Kawaguchi, Y, Unemura, S (1993) Suppression of secondary hyperparathyroidism in chronic dialysis patients by single oral weekly dose of 1,25-dihydroxycholecalciferol. Intern Med 32: pp. 695-701
- Teng, M, Wolf, M, Lowrie, E (2003) Survival of patients undergoing hemodialysis with paricalcitriol or calcitriol therapy. N Engl J Med 349: pp. 446-56 CrossRef
- Block, GA, Hulbert-Shearon, TE, Levin, NW (1998) Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31: pp. 607-18
- K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42:S77–S84
- Comparison of the efficacy of an oral calcitriol pulse or intravenous 22-oxacalcitriol therapies in chronic hemodialysis patients
Clinical and Experimental Nephrology
Volume 9, Issue 3 , pp 238-243
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Secondary hyperparathyroid-ism
- 22-oxacalcitriol (OCT)
- Oral calcitriol pulse therapy
- Industry Sectors
- Author Affiliations
- A1. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
- A2. Saiseikai Hospital, Maebashi, Japan
- A3. Nishikatakai Clinic, Maebashi, Japan