Original Report: Patient-Oriented, Translational Research
Differential Effects of Paricalcitol and Calcitriol on Intestinal Calcium Absorption in Hemodialysis PatientsLund R.J.a · Andress D.L.b · Amdahl M.b · Williams L.A.b · Heaney R.P.a
aDepartment of Medicine, Creighton University, Omaha, Nebr., and bAbbott Laboratories, Abbott Park, Ill., USA
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Article / Publication Details
Background/Aims: Increased parathyroid activity associated with chronic kidney disease is often managed with calcitriol, which can elevate serum calcium (Ca) by increasing bone resorption and intestinal absorption, whereas paricalcitol promotes less bone resorption. This study compared intestinal Ca absorption in hemodialysis patients treated with calcitriol versus paricalcitol (dose ratio 1:3). Methods: Patients (n = 22) aged ≧20 years, on maintenance hemodialysis for ≧2 months with intact parathyroid hormone (iPTH) levels of >200 pg/ml were enrolled in a single-center, double-blind, active-controlled, randomized, crossover trial. Mean fractional intestinal Ca absorption (±SE) was measured by the single-tracer method (42Ca) and evaluated with an analysis of variance crossover model. Results: Mean fractional intestinal Ca absorption was significantly lower after paricalcitol (0.135 ± 0.006) versus calcitriol treatment (0.158 ± 0.006, p = 0.022), a 0.023 difference in absolute Ca absorption fraction. Overall Ca absorption was low in the study population, indicating that regulation of Ca absorption may be dysfunctional. There were no significant differences in serum PTH, Ca, phosphorus (P), or Ca × P. Conclusion: Overall, paricalcitol-treated patients absorbed ∼14% less Ca compared with calcitriol-treated patients with similar effects on PTH. In hemodialysis patients, paricalcitol may provide a benefit by lowering the Ca available for removal by dialysis and/or for deposit in bone or soft tissues.
© 2009 S. Karger AG, Basel
- Llach F, Yudd M: Pathogenic, clinical, and therapeutic aspects of secondary hyperparathyroidism in chronic renal failure. Am J Kidney Dis 1998;32:S3–S12.
- Silver J, Kilav R, Naveh-Many T: Mechanisms of secondary hyperparathyroidism. Am J Physiol Renal Physiol 2002;283:F367–F376.
- Slatopolsky E, Brown A, Dusso A: Pathogenesis of secondary hyperparathyroidism. Kidney Int 1999;56:S14–S19.
- Slatopolsky E, Brown A, Dusso A: Role of phosphorus in the pathogenesis of secondary hyperparathyroidism. Am J Kidney Dis 2001;37:S54–S57.
- Coyne DW, Grieff M, Ahya SN, et al: Differential effects of acute administration of 19-nor-1,25-dihydroxy-vitamin D2 and 1,25-dihydroxy-vitamin D3 on serum calcium and phosphorus in hemodialysis patients. Am J Kidney Dis 2002;40:1283–1288.
- Brown AJ, Finch J, Slatopolsky E: Differential effects of 19-nor-1,25-dihydroxyvitamin D(2) and 1,25-dihydroxyvitamin D(3) on intestinal calcium and phosphate transport. J Lab Clin Med 2002;139:279–284.
- Finch JL, Brown AJ, Slatopolsky E: Differential effects of 1,25-dihydroxy-vitamin D3 and 19-nor-1,25-dihydroxy-vitamin D2 on calcium and phosphorus resorption in bone. J Am Soc Nephrol 1999;10:980–985.
- Coyne D, Acharya M, Qiu P, et al: Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD. Am J Kidney Dis 2006;47:263–276.
- Martin KJ, Gonzalez EA, Gellens M, et al: 19-nor-1-alpha-25-dihydroxyvitamin D2 (paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998;9:1427–1432.
- Goodman WG, Goldin J, Kuizon BD, et al: Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000;342:1478–1483.
- Raggi P, Bommer J, Chertow GM: Valvular calcification in hemodialysis patients randomized to calcium-based phosphorus binders or sevelamer. J Heart Valve Dis 2004;13:134–141.
- Ketteler M, Wanner C, Metzger T, et al: Deficiencies of calcium-regulatory proteins in dialysis patients: a novel concept of cardiovascular calcification in uremia. Kidney Int 2003;63:S84–S87.
- Moe SM, O’Neill KD, Duan D, et al: Medial artery calcification in ESRD patients is associated with deposition of bone matrix proteins. Kidney Int 2002;61:638–647.
- Ahmed S, O’Neill KD, Hood AF, et al: Calciphylaxis is associated with hyperphosphatemia and increased osteopontin expression by vascular smooth muscle cells. Am J Kidney Dis 2001;37:1267–1276.
- Hsu CH: Are we mismanaging calcium and phosphate metabolism in renal failure? Am J Kidney Dis 1997;29:641–649.
- Llach F, Yudd M: Paricalcitol in dialysis patients with calcitriol-resistant secondary hyperparathyroidism. Am J Kidney Dis 2001;38:S45–S50.
- Sprague SM, Llach F, Amdahl M, et al: Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int 2003;63:1483–1490.
- Bailie GR, Johnson CA: Comparative review of the pharmacokinetics of vitamin D analogues. Semin Dial 2002;15:352–357.
- Heaney RP, Recker RR: Estimation of true calcium absorption. Ann Intern Med 1985;103:516–521.
- Heaney RP, Recker RR: Estimating true fractional calcium absorption. Ann Intern Med 1988;108:905–906.
- Heaney RP: Quantifying human calcium absorption using pharmacokinetic methods. J Nutr 2003;133:1224–1226.
- Abrams SA, Yergey AL, Heaney RP: Relationship between balance and dual tracer isotopic measurements of calcium absorption and excretion. J Clin Endocrinol Metab 1994;79:965–969.
- Heaney RP, Dowell MS, Wolf RL: Estimation of true calcium absorption in men. Clin Chem 2002;48:786–788.
- Chen Z, Griffin IJ, Kriseman YL, et al: Inductively coupled plasma mass spectrometric analysis of calcium isotopes in human serum: a low-sample-volume acid-equilibration method. Clin Chem 2003;49:2050–2055.
- Brown AJ, Finch J, Takahashi F, et al: Calcemic activity of 19-nor-1,25(OH)(2)D(2) decreases with duration of treatment. J Am Soc Nephrol 2000;11:2088–2094.
- Martin KJ, Gonzalez EA, Gellens ME, et al: Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2. Am J Kidney Dis 1998;32:S61–S66.
- Vergne-Marini P, Parker TF, Pak CY, et al: Jejunal and ileal absorption in patients with chronic renal disease. Effect of 1alpha-hydroxycholecalciferol. J Clin Invest 1976;57:861–866.
- Block GA, Hulbert-Shearon TE, Levin NW, et al: Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J of Kidney Dis 1998;31:607–617.
- Lowrie EG, Lew NL: Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458–482.
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