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Perit Dial Int 27(Supplement_3): 16- 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical Experience

Use of Intravenous Paricalcitol in Peritoneal Dialysis Patients Improved Control of Secondary Hyperparathyroidism

A. Hamad1, A. Geneidy2, P. Still3, M. Goodwin3 and R. Poole3

Palmetto Nephrology1 ; South Carolina Nephrology and Hypertension2 ; Davita Dialysis,3 Orangeburg, South Carolina, USA.

Objective: To study the efficacy of intravenous (IV) paricalcitol in peritoneal dialysis (PD) patients (pts) with secondary hyperparathyroidism (SHPT). Medication coverage is problematic in PD. Although adynamic bone disease is more common in PD, there are still many pts with SHPT. Medication noncompliance and prices makes management difficult. Only 1 report described the use of IV calcitriol in PD pts with comparable results to oral calcitriol. Medline search showed no similar trials using IV paricalcitol. Methods: We targeted pts who have intact parathyroid hormone (iPTH) above the Dialysis Outcomes Quality Initiative guidelines (19/32 pts) who either cannot afford buying their medicine or have a history of medication noncompliance. IV paricalcitol was started instead of oral paricalcitol. It was given once or twice weekly with dose increased to achieve targets. We monitored iPTH, calcium, and phosphorus biweekly to monthly. Use of phosphate binders and cinacalcet was recorded. Results: 5 pts were included (2 females). Mean age was 49 years. Three were included for medication cost burden and 2 for medication noncompliance. Time on PD prior to IV paricalcitol was 9–36 months with a mean of 18 months. Three pts were on a stable dose of cinacalcet with an average dose of 90 mg daily. All pts received phosphate binders per protocol. IV paricalcitol was given for 5 months. Dose at the end of the trial was 7–26 µg/week with a mean of 17.7 µg/week. Two pts received it once weekly and 3 twice weekly. At baseline 3 pts had iPTH above 900 and only 1 was within target (iPTH 200–350 pg/mL). At the end of the study, 3 pts achieved target levels and the highest iPTH was 643 pg/mL. There was no significant change in calcium and phosphorus levels throughout the study period.

Table: Improvement in iPTH Mean Levels with IV Paricalcitol Baseline iPTH 1st month 2nd month 3rd month 4th month 5th month 852 721 660 533 515 408

Conclusions: Our study showed that IV paricalcitol was effective in improving iPTH control in noncompliant PD pts. We believe that IV paricalcitol has a role in achieving target iPTH along with standard oral therapies.






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