経口ビタミンＤ３ならびに静注ビタミンＤアナログ製剤による二次性副甲状腺機能こう進症に対する層別治療の検討

DOI

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タイトル別名
  • Effective therapeutic strategies of oral vitamin D3 and intravenous maxacalcitol on secondary hyperparathyroidism in chronic hemodialysis patients: a prospective trial

抄録

To clarify the effective therapeutic strategies of either oral vitamin (Vit) D3 on intravenous maxacalcitol (22-oxacalcitriol, OCT) on secondary hyperparathyroidism (2nd HPT) in chronic hemodialysis patients, they were subdivided according to serum intact-PTH (iPTH) levels. We conducted a randomized prospective study for 59 patients (40 males, 19 females with mean age of 57.4±15.4 years old, serum iPTH more than 150pg/mL, serum Ca<11mg/dL, Ca×P product<70mg2/dL2). The current study evaluates the use of oral VitD3 or i. v. OCT in relation to the severity of 2nd HPT. Arbitrarily, patients with serum iPTH more than 150 and <300pg/mL were given initially oral VitD3 0.25μg/day (Group IA, n=10) or 2.5μg i. v. OCT at the end of each dialysis (Group IB, n=10). Patients with iPTH more than 300 and <50pg/mL received 2.5μg i. v. (Group IIA, n=12) or 5μg i. v. (Group IIB, n=11) and patients with iPTH more than 500pg/mL were given 5μg i. v. (Group IIIA, n=8) or 10μg i. v. (Group IIIB, n=8). We adjusted the dose of i. v. OCT by serum iPTH or Ca levels after initial 4 weeks treatment, and followed-up the patients with mean of 19.7±7.8 months. During the study period, the average serum iPTH levels were significantly decreased from 437±31 to 256±28pg/mL (p<0.001). In subgroups B, serum iPTH levels decreased significantly after 4 weeks treatment, but i. v. OCT was stopped in patients of IIB or IIIB because of the increase in serum Ca levels over 11.5mg/dL and clinical symptoms. There was no significant difference of serum iPTH and Ca levels between two subgroups (A and B) of each group (I, II, III) from the 12 week of follow-up. Serum inorganic phosphorus level remained the same value in each subgroup. Elevated serum bone specific alkaline phosphatase and intact osteocalcin levels decreased significantly in group III after 12 weeks treatment. There was no difference in serum alkaline phosphatase and the doses of i. v. OCT among three groups at the end of the study. In conclusion, the study presented here demonstrated that it is an effective and safe therapeutic strategy to decide the initial treatment either oral VitD3 or i. v. OCT evaluating with serum iPTH levels.

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詳細情報 詳細情報について

  • CRID
    1390001204677223680
  • NII論文ID
    130003721816
  • DOI
    10.4009/jsdt.37.223
  • ISSN
    1883082X
    13403451
  • 本文言語コード
    ja
  • データソース種別
    • JaLC
    • Crossref
    • CiNii Articles
  • 抄録ライセンスフラグ
    使用不可

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