Malberti F, Scanziani R, Corradi B, Dozio B, Bonforte G, Imbasciati E, Surian M
Servizio Dialisi, Ospedale Maggiore, Lodi, Italy.
Nephrol Dial Transplant. 1994;9(12):1813-5.
We evaluated the effect of pulse oral calcitriol (4 micrograms three times weekly for 6 months) on parathyroid function in nine CAPD patients with hyperparathyroidism refractory to conventional low-dose oral calcitriol. Zero calcium peritoneal solutions were used to prevent the development of hypercalcaemia. The peritoneal loss of calcium increased from 168 +/- 40 to 417 +/- 48 mg/day using zero calcium solutions. Pulse oral calcitriol resulted in a significant decrease in PTH (from 617 +/- 272 to 382 +/- 299 pg/ml) by the 15th day of therapy, while serum iCa did not change from baseline. During the first month of therapy the mean PTH levels remained significantly reduced compared to baseline, thereafter PTH increased in four of nine patients. Hyperphosphataemia was not satisfactorily controlled in four patients, despite large amounts of binders used; seven of nine patients developed hypercalcaemia and required either the substitution of calcium acetate for calcium carbonate or reduction of calcitriol dose. Three patients showed a progressive increase in PTH. In conclusion our data suggest that in most CAPD patients with severe hyperparathyroidism oral calcitriol pulse therapy is not effective in maintaining a permanent suppression in PTH levels.
我们评估了脉冲式口服骨化三醇（每周三次，每次4微克，共6个月）对9例常规低剂量口服骨化三醇治疗无效的持续性非卧床腹膜透析（CAPD）甲状旁腺功能亢进患者的影响。使用零钙腹膜透析液以预防高钙血症的发生。使用零钙透析液时，腹膜钙丢失量从168±40毫克/天增加至417±48毫克/天。脉冲式口服骨化三醇治疗第15天时，甲状旁腺激素（PTH）显著下降（从617±272皮克/毫升降至382±299皮克/毫升），而血清离子钙（iCa）与基线相比无变化。治疗的第一个月内，平均PTH水平与基线相比仍显著降低，此后9例患者中有4例PTH升高。4例患者的高磷血症未得到满意控制，尽管使用了大量的磷结合剂；9例患者中有7例发生高钙血症，需要将醋酸钙替换为碳酸钙或减少骨化三醇剂量。3例患者的PTH呈进行性升高。总之，我们的数据表明，对于大多数严重甲状旁腺功能亢进的CAPD患者，口服骨化三醇脉冲疗法无法有效维持PTH水平的长期抑制。
