Abstract

Aim: Intravenous vitamin D therapy is an established treatment for secondary hyperparathyroidism (SHPT). However, no protocols have been established for maintenance therapy with intravenous or oral vitamin D after control of intact parathyroid hormone (iPTH) within the target range. Methods: Step I. For patients with SHPT (200 ≤ iPTH ≤ 500 pg/ml), a dose of 2.5 mg maxacalcitol (OCT) was administered intravenously three times a week with oral sevelamer hydrochloride; the dose was increased to a 10 µg maximum three times a week to control iPTH to < 150 pg/ml. Step II. When iPTH reached the target level, patients were assigned to Group A (oral alfacalcidol 1.0 µg/day) or B (oral alfacalcidol 0.25 µg/ day). Serum iPTH, calcium, and inorganic phosphorus were measured each month for 6 months. Maintenance rates for the target iPTH levels were evaluated, < 150 pg/ml at Step I and < 200 pg/ml at Step II. Results: iPTH decreased to < 150 pg/ml by OCT in 24 of 35 patients (68.6%). During the 24-week observation period, iPTH was controlled for 83.3% patients in Group A vs. 36.4% for Group B (p < 0.05). No dropouts due to hypercalcemia or hyperphosphatemia occurred. Conclusion: OCT dose titration was effective for SHPT. A higher daily dose of oral alfacalcidol (1.0 µg) appears to be more effective than a lower dose (0.25 µg) as maintenance therapy after iPTH control.

Author Details

Authors

• M. Adachi¹
• T. Miyoshi¹
• N. Shiraishi¹
• H. Shimada²
• S. Sakaguchi³
• K. Tomita¹
• K. Kitamura¹

Departments

• ¹ Department of Nephrology, Kumamoto University Graduate School of Medical Sciences,
• ² Josuikai Shimada Hospital, Kumamoto and
• ³ Gyokuwakai Midorigaoka Clinic, Arao, Japan

Address

M. Adachi, MD, PhD, Assistant Professor
Department of Nephrology
Kumamoto University Graduate
School of Medical Sciences
1-1-1 Honjo, Kumamoto
Kumamoto 860-8556, Japan
Email: [email protected]

Citation