Paricalcitol reduces in an efficient way the serum parathyroid hormone levels in patients in chronic hemodialysis: experience in Argentina

Abstract

Introduction: Secondary hyperparathyroidism (sHPT) is a frequent complication of chronic renal failure. Paricalcitol is a vitamin D receptor activator that has shown to be effective in reducing serum intact parathyroid hormone (PTHi) levels, differenciating itself from calcitriol as it induces less increase in serum calcium and phosphorus. Objective: Our aim was to evaluate the efficacy and security of paricalcitol in hemodialysis patients with sHPT. Methods: We performed a multicentre retrospective analysis of 66 hemodialysis patients that received paricalcitol for at least three months up to a maximum of one year as treatment of their sHPTs. Results: Of the patients that began paricalcitol, 51% (34/66) completed one year treatment. The median baseline iPTH was 894 pg/ml (range 589-1413). iPTH levels decreased significantly to 557 (range 365-1026) P< 0.0001, 504 (range 260-958) P< 0.0001 and 333 pg/ml (range 280-686) P< 0.0001 at 3, 6 and 12 months respectively. Baseline alkaline phosphatase was 411 UI/l (range 308-609) and decreased to 250 UI/l (172-449) at 12 months. Calcium and phosphorus serum levels as well as the Ca/P product remained stable along the study. The mean paricalcitol dose at the beginning of the treatment was 8.2 ± 3.3 µg. The dose was reduced during the study to 7.1 ± 3.0 µg at 3 months, to 6.7 ± 2.9 µg at 6 months and to 5.9 ± 2.4 µg at one year. Paricalcitol was stopped in two patients due to the lack of response and in 3 patients because of a permanent increase of calcium and/or phosphorus serum levels. Conclusion: We conclude that Paricalcitol produced a rapid and sustained reduction of serum iPTH levels, with minimal effect on serum calcium and phosphorus levels, becoming a good alternative in sHPT treatment.