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21 Review of Treatment with Vitamin D: Ten Month Observation
Author(s) -
Malovrh M,
Premru V
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_21_21.x
Subject(s) - medicine , hyperphosphatemia , secondary hyperparathyroidism , vitamin d and neurology , hemodialysis , dialysis , hyperparathyroidism , gastroenterology , parathyroid hormone , urology , phosphate binder , kidney disease , vitamin , endocrinology , calcium
Hyperparathyroidism continues to be a major problem in patients with chronic kidney disease (CKD). Hypocalcemia and hyperphosphatemia are crucial for the development of secondary hyperparathyroidism (SHP). Preventing hyperphosphatemia ameliorates the progression of SHP. Vitamin D analogs (Alpha D3) per oral after hemodialysis (HD) could be used in the therapy of SHP. The purpose of this review in one dialysis center was to analyze the quality of such treatment. Patients and methods Patients (pts) on HD in one dialysis center were included in this analysis. Calcium (Ca) and phosphate (P) were followed during a 10 month period every 3 weeks and intact parathyroid hormone (iPTH) every three months. Vitamin D was given after HD per oral under nurse control. Results Sixty‐four pts, 34 female and 30 male, mean age 59.9 ± 11.5 (range 32–82) years, HD treatment length mean 8.8 ± 7.2 (range 0.7–30.7) years were observed. Mean Ca was 2.46 ± 0.04 mmol/L, (range from 1.06 to 2.72), mean P 1.52 ± 0.08 mmol/L (range from 0.62 to 3.53), mean iPTH 211.9 ± 36.7 ng/L (range from 1 to 699). Mean calcium concentration in dialysis fluid was 1.51 ± 0.02 mmol/L and mean dose of vitamin D was 0.35 ± 0.11 mg. Mean values of parameters during the 10 months observation are shown in Table A21. A21December
2003 February
2004 April
2004 June
2004Ca (mmol/L) 2.46 2.44 2.35 2.38 P (mmol/L/ 1.52 1.56 1.71 1.53 iPTH (ng/L) 204.8 173.1 272.3 196.5 Ca in fluid (mmol/L) 1.52 1.53 1.49 1.49 Dose of vitamin D (mg) 0.47 0.28 0.21 0.43Conclusions Regular evaluation of Ca, P, iPTH and strict correction of calcium concentration in dialysis fluid, per oral vitamin D are very helpful in prevention of SHP. Critical elevation of iPTH was in pts with low compliance in hypophosphatemic diet and therapy. If concentration of phosphate is normal, elevated iPTH could be diminished very effective by titration of vitamin D.