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Perit Dial Int 27(6): 681-686 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical

INTRAPERITONEAL CALCITRIOL IN INFANTS ON PERITONEAL DIALYSIS

Francisco J. Cano1, Marta A. Azocar1, Jose Luis Guerrero1, Maria A. Delucchi1, Ana Maria Lillo1, Marcos Emilfork2 and Eugenio E. Rodríguez1

Division of Pediatric Nephrology,1 Luis Calvo Mackenna Children's Hospital, Department of Pediatrics, University of Chile; Division of Pediatrics,2 Clinica Santa Maria, Santiago, Chile

Correspondence to: F.J. Cano, El Vergel 2828, Appt 603, Providencia, 6650813, Santiago, Chile. fcano{at}med.uchile.cl

{diamondsuit} Background: Calcitriol has long been used as the main therapy in renal osteodystrophy, but the efficacy of the oral route is not always as high as expected.

{diamondsuit} Objective: To asses the safety and efficacy of intraperitoneal calcitriol in infants undergoing peritoneal dialysis (PD).

{diamondsuit} Patients and Methods: PD patients on oral calcitriol therapy, with serum parathyroid hormone (PTH) >1000 pg/mL during the previous 3 months of treatment, were switched to intraperitoneal calcitriol therapy, 1 µg twice per week. Dose was increased to 1 µg three times per week if PTH remained >1000 pg/mL, and was later readjusted. Target PTH was 200–300 pg/mL according DOQI guidelines. Statistics: All results are expressed as mean ± SE. The Wilcoxon signed rank test was used to evaluate differences in measurements for each pair of values. The confidence interval for differences between population medians was 96.9%. A p value less than 0.05 was considered significant.

{diamondsuit} Results: Six male children, mean age 17 ± 3.86 months, completed a 12-month follow-up. Mean pretreatment PTH was 1654 ± 209 pg/mL. Mean PTH at months 0, 3, 6, 9, and 12 was 1448 ± 439*, 1277 ± 723, 910 ± 704, 582 ± 282*, and 465 ± 224* pg/mL, respectively (*p < 0.05). Twelve hypercalcemic and 10 hyperphosphatemic episodes were successfully treated.

{diamondsuit} Conclusion: Infants on PD who fail to respond to oral calcitriol therapy can be safely treated with intraperitoneal administration of active vitamin D.

KEY WORDS: Renal osteodystrophy; calcitriol; pulses; intraperitoneal vitamin D; parathyroid hormone; children.

Received 30 July 2006; accepted 18 May 2007.






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