Felipe C, Miranda B, Selgas R, Martinez M E, Miguel J L, Moreno F, Caparros G, Torre A, Sicilia L S
Hospital La Paz, Madrid, Spain.
Adv Perit Dial. 1990;6:238-41.
Secondary hyperparathyroidism (HP) is well known complication of long-term uremia. CAPD patients show a peculiar behaviour due to loss of vitamin D metabolites through peritoneum. Severe degrees of hyperparathyroidism may require parathyroidectomy in order to achieve appropriate control. Recently, the possibility of controlling this situation with high oral doses of calcitriol has been communicated. The purpose of this study is to evaluate the effect of this agent on hyperparathyroidism in CAPD patients. Two different groups were constituted according to the length of time on dialysis when HP was detected. All of the patients had i-PTH serum levels five times higher than the normal values (50 pg/ml). During a six month period the daily dose of oral calcitriol was increased in order to achieve a reduction in i-PTH level. The results after this period showed a significant reduction in i-PTH levels (614 +/- 378 to 241 +/- 80 pg/ml) with an average increase in oral calcitriol from 0.16 +/- 0.1 to 0.67 +/- 0.4 with no significant changes in serum calcium or phosphorus. The group with HP at start of dialysis achieved these effects easier and with lower doses of calcitriol. We conclude that moderately high doses of oral calcitriol control secondary hyperparathyroidism in CAPD patients without hypercalcemia.
继发性甲状旁腺功能亢进（HP）是长期尿毒症的一种众所周知的并发症。持续性非卧床腹膜透析（CAPD）患者由于维生素D代谢产物通过腹膜丢失而表现出特殊的情况。严重程度的甲状旁腺功能亢进可能需要进行甲状旁腺切除术以实现适当的控制。最近，有报道称口服大剂量骨化三醇有可能控制这种情况。本研究的目的是评估该药物对CAPD患者甲状旁腺功能亢进的影响。根据检测到HP时透析时间的长短组成了两个不同的组。所有患者的血清免疫反应性甲状旁腺激素（i-PTH）水平均高于正常值（50 pg/ml）的五倍。在六个月的时间里，口服骨化三醇的每日剂量增加，以降低i-PTH水平。这段时间后的结果显示，i-PTH水平显著降低（从614±378降至241±80 pg/ml），口服骨化三醇平均从0.16±0.1增加到0.67±0.4，而血清钙或磷无显著变化。透析开始时就患有HP的组更容易达到这些效果，且所需的骨化三醇剂量更低。我们得出结论，中等高剂量的口服骨化三醇可在不引起高钙血症的情况下控制CAPD患者的继发性甲状旁腺功能亢进。
