Renal osteodystrophy (ROD) represents a relevant and frequent complication ofchronic renal failure; although the spectrum ofROD is broad secondary hyperparathyroidism remains its most commonly encountered histological pattern. Alfacalcidol, taken orally or administered intravenously, is known to reverse the complication of chronic renal failure induced osteodystrophy (ROD).
In this study (29) Endstage renal disease (ESRD) patients, who were on dialysis (19 on hemodialysis and 10 on peritoneal dialysis) for longer than six months and having serum parathormone (PTH) levels at least four times normal and serum calcium less than 2.1 mmollL, were randomly allocated to treatment with oral or intravenous (i. v.) alfacalcidol for a period of one year.
There were nine patients on hemodialysis (HD) and six on peritoneal dialysis (PD) in the oral treatment group, while in the i. v. group there were ten on hemodialysis and four on peritoneal dialysis. Clinical and serial biochemical assessments showed no statistically significant difference between the orally and i. v. treated patients in terms ofsuppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features ofmild ROD on bone histology which is repeated after 12 months of treatment showed significant improvement, also the dual photon study and quantitative CT revealed improvement of bone mineral density in both treatment groups.
AMJ Vol. 52 No.4, 5, & 6 (2001)
587
Mahdy M.M. et al.
In conclusion, both oral and i. v. alfacalcidol, administered intermittently, ?re able to equally suppress secondary hyperparathyroidism in dialysis !tients. This was shown by improvement in PTH levels as well as improve'Jnt in bone histomorphometry and bone density.
We further support the use of intermittent oral alfacalcidol in chronic rerl failure patients because of easy administration, convenience, and cost f'ectiveness in addition to the potency regarding the control ofthe hyperpathyroid status ofthe patients with (ESRD). |
