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Severe Hyperparathyroidism Despite Paricalcitol (Zemplar) Therapy: One Year Follow‐up
Author(s) -
Suhail B,
Rasib M
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01229.x
Subject(s) - medicine , paricalcitol , secondary hyperparathyroidism , calcitriol , hemodialysis , hyperparathyroidism , gastroenterology , hemoglobin , albumin , endocrinology , dialysis , vitamin d and neurology , urology , parathyroid hormone , calcium
Paricalcitol, a new Vit. D analogue is thought to be more potent than Calcitriol and has also been reported to cause less hypercalcemia. We report one‐year follow‐up on patients (N = 74) from one inner city dialysis unit. Patients were stratified in groups A, B, C, D depending on intact Paratharmone (iPTH) levels i.e., < 100, 100–300, 300–600, > 600 respectively. Serum Ca, PO 4 , alkaline phosphatase (ALK), albumin (ALB), hemoglobin (Hb) was measured monthly and serum iPTH was checked quarterly. The results are as follows:Group # PTH Ca PO4 ZPR Hb EPOpg/dl mg/dl mg/dl mcg/hd g/dl U/kg/hdA 6 56.83* 9.74 5.32 0 11.72 255.8† B 22 197.01** 9.04 5.53 2.48¶ 12.12 137.55 C 29 422.89** 9.4 5.73 4.54¶¶ 11.86 128.87 D 17 1253.4** 9.88 7.21 12.51¶¶ 12.1 74.35††PTH : p < 0.05 = *vs**, ZPR (zemplar): p < 0.05¶ vs¶¶, mcg: microgram EPO (erythropoietin): p < 0.05 = † vs††, Mean age, weight, URR, ALB., ALK. and iron indices were not statistically different in all groups. Mean duration of hemodialysis (HD) was 34, 30, 57 & 65 months in groups A, B, C, D respectively. None of these patients had symptomatic bone disease. Seven patients were changed to low Ca (1.0 meq/L) bath secondary to hypercalcemia (Ca > 11.5) & severe hyperparathyroidism (HPT). This data suggest that severe HPT is frequent despite aggressive Paricalcitol therapy in the inner city HD population. More effective noncalcium phosphate binders and/or calcimimetic agents may be needed in addition to dietary and medication compliance in group D to control severe HPT. Interestingly patients with low PTH (< 100) showed relative epogen resistance while patients in group D required smaller epogen doses. There was inverse relationship between ZPR & EPO dosage. The effect of ZPR on EPO responsiveness needs to be confirmed in larger study.