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Intermittent intravenous followed by intermittent oral 1 alpha(OH)D3 treatment of secondary hyperparathyroidism in uraemia

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OBJECTIVES: To examine whether intermittent oral 1 alpha(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1 alpha(OH)D3. Simultaneously, the effect of the different routes of administration of 1 alpha(OH)D3 on the circulating levels of N- and C-terminal PTH fragments was measured.

DESIGN: An open study of patients on chronic haemodialysis.

SETTING: Renal division, Rigshospitalet, Copenhagen, Denmark.

SUBJECTS: A total of 26 patients started and five patients completed the total protocol.

INTERVENTIONS: The treatment protocol was divided into three parts: (i) 1 alpha(OH)D3 administered intravenously for > 300 days; then (ii) 1 alpha(OH)D3 administered orally for 100 days, followed by (iii) 1 alpha(OH)D3 administered intravenously again for another 100 days. 1 alpha(OH)D3 was given three times a week at the end of each dialysis.

MAIN OUTCOME MEASURES: Intact PTH, N- and C-terminal PTH.

RESULTS: Intact PTH levels were significantly (P < 0.0001) suppressed by 90.4 +/- 3.3% after 56 days of intermittent intravenous 1 alpha(OH)D3 treatment. This degree of suppression remained stable during the following period of oral treatment and did not change further when intravenous treatment was reinstituted. The circulating levels of intact PTH and N- and C-terminal iPTH were not influenced by the administered route of 1 alpha(OH)D3.

CONCLUSIONS: Intravenous 1 alpha(OH)D3 treatment of the secondary HPT in dialysis patients can safely be changed to oral treatment at the time when optimal suppression of PTH has been achieved.

OriginalsprogEngelsk
TidsskriftJournal of Internal Medicine
Vol/bind239
Udgave nummer4
Sider (fra-til)353-60
Antal sider8
ISSN0954-6820
StatusUdgivet - 1996

ID: 51473166