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Titolo Paricalcitol Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients on Sevelamer Hydrochloride: Which Dialysate Calcium Concentration to Use?
Autore Macroui Sonikian a Polyxeni Metaxaki a Ioannis Karatzas b Dimosthenis Vlassopoulos a -Departments of a Nephrology and b Biochemistry, A. Fleming General Hospital, Athens , Greece
Referenza Blood Purif 2009; 27:182-186
Contenuto Background: Optimal dialysate calcium concentration (DCa) has not been determined under less hypercalcemic vitamin D analogues and Ca-free phosphate (P) binders. Methods: Twelve hyperparathyroidic hemodialysis patients under sevelamer hydrochloride were treated with paricalcitol in three periods (A, B and C) under DCa of 3.5, 3 and 2.5 mEq/l, respectively, in a 3-way open-label randomized crossover study. Results: Serum parathyroid hormone decreased in all periods. Under DCa = 2.5 mEq/l, there was a need for longer treatment duration, higher paricalcitol doses and increased sevelamer doses for higher serum P levels. No differences in serum Ca were observed. Ca ! P values followed P changes. Episodes of Ca ! P 1 55 mg 2 /dl 2 were more frequent in the C period. Conclusions: Under paricalcitol and sevelamer, serum parathyroid hormone decreased without Ca increase under any DCa. DCa of 2.5 mEq/l resulted in higher paricalcitol doses, increased serum P levels and more frequent high Ca ! P episodes and may not be optimal with the new medications.
Data 05.02.2009
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