The Beneficial Effect of Paricalcitol (Zemplar) on Secondary hyperparathyroidism Refractory to Calcitriol (Calcijex) and Cinacalcet HCl (Mimpara) in Patients on Maintenance Hemodialysis: A Prospective and Crossover Study
Paricalcitol, 19-nor-1, 25-dihydroxvitamin D2, is a novel 1,25–dihydroxyvitamin D2 analogue, which has greater potential to suppress parathyroid hormone without inducing significant hypercalcemia and hyperphosphatemia. We therefore investigated its role in treatment of patients with moderate to severe secondary hyperparathyroidism (SHPT) who were refractory to conventional therapy with Calcitriol and Cinacalcet HCl. Eight patients were recruited in whom conventional therapy was stable over the past 3 months. After a washout period of 2 weeks, calcijex injections were replaced by Paricalcitol. Paricalcitol induced more suppression of iPTH compared to the conventional therapy without significant hypercalcemia, hyperphosphatemia or side effects. The conversion ratio was approximately 1:2.5 (calcitriol:paricalcitol). In conclusion, injectable Paricalcitol is superior to Calcitriol in treatment of SHPT.
Keywords: Cinacalcet, Calciferol, hemodialysis, hyperparathyroidism, Paricalcitol.
2- Brown EM, Wilson RE, Eastman R. Abnormal regulation of parathyroid hormone release by calcium in secondary hyperthyroidism due to chronic renal failure. J Clin Endocrinol Metab 1982; 54:172-179.
3- Liach F. Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited. Am J Kidney Dis 1995; 25: 663-679.
4- Massry, SG, Smogorzewski, M. Mechanisms through which parathyroid hormone mediates its deleterious effects on organ function in uremia. Semin Nephrol 1994; 14:219-231.
5- El-Reshaid K, El-Reshaid W, Sugathan TN, Al-Muhanadi S, Sivanandan R. Comparison of the efficacy of two injectable forms of vitamin D3 and oral one alpha in treatment of hyperparathyroidism in patients on maintenance haemodialysis. Am J Nephrol 1997; 17:505-510.
6- Gallieni M, Brancaccio D, Padovese P, et al. Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients. Italian Group for the study of intravenous Calcitrol. Kidney Int 1992; 42: 1191-1198.
7- Hruska KA, Teitelbaum SL. Renal osteodystrophy. N Engl J Med 1995; 333:166-174.
8- Block GA, Hulbert-Sharon TE, Levin NW, et al. Association of serum phosphorus and calcium X phosphorus product with mortality risk in chronic hemodialysis patients: A national study. Am J Kidney Dis 1998; 31:607-617.
9- Sharon M, Glenn C, Jack C, et al. Achieving NKF-K/DOQI TM bone metabolism and disease treatment goals with cinacalcet HCl. Kidney Int 2005; 67:760-771.
10- Martin KJ, Gonzalez EA, Gellens M, et al. 19-Nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduced the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998; 9:1427-1432.
11- Mizobuchi M, Finch JL, Martin DR, Slatopolsky E. Differential effects of vitamin D receptor activators on vascular calcification in uremic rats. Kidney Int 2007; 1-7.
12- Teng M, Wolf M, Lowrie E, Ofsthun N, Lazarus M, Thadhani R. Survival od patients undergoing hemodialysis with Paricalcitol or Calcitriol therapy. N Engl J Med 2003; 349:446-456.
13- Dobrez DG, Mathes A, Amdahl M, Marx SE, Melnick JZ, Sprague SM. Paricalcitol-treated patients experience improved hospitalization outcomes compared with calcitriol-treated patients in real-world clinical settings. Nephrol Dial Transplant 2004; 19:1174-1181.
14- Mittman N, Khanna R, Chattopadhyay J, et al. Paricalcitol therapy for secondary hyperparathyroidism in patients on maintenance hemodialysis previously treated with calcitriol: a single-center crossover study. Kidney Int 2006; 70:S64-67.
15- Desiraju B, Mittman N, Meyer K, et al. Treatment of secondary hyperparathyroidism (SHPT) with paricalcitol (P) versus calcitriol (C) : a two year, single center crossover comparison [abstract no. SA-PO1009]. American Society of Nephrology (ASN) 39th Renal Week Meeting; 2006 November 14-19; San Diego (CA).
16- Capuano A, Serio V, Pota A, Memoli B, Andreucci VE. Beneficial effects of better control of secondary hyperparathyroidism with paricalcitol in chronic dialysis patients. J Nephrol 2009; 22:59-68.
17- Brancaccio D, Bommer J, Coyne D. Vitamin D receptor activator selectivity in the treatment of secondary hyperparathyroidism: understanding the differences among therapies. Drugs 2007; 67:1981-1998
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