Differential effects of paricalcitol and calcitriol on intestinal calcium absorption in hemodialysis patients

Richard J. Lund, Dennis L. Andress, Michael Amdahl, Laura A. Williams, Robert P. Heaney

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)165-170
Number of pages6
JournalAmerican Journal of Nephrology
Volume31
Issue number2
DOIs
StatePublished - Feb 2010

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Calcitriol
Intestinal Absorption
Renal Dialysis
Calcium
Bone Resorption
paricalcitol
Parathyroid Hormone
Serum
Chronic Renal Insufficiency
Cross-Over Studies
Phosphorus
Dialysis
Analysis of Variance
Maintenance
Bone and Bones

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Differential effects of paricalcitol and calcitriol on intestinal calcium absorption in hemodialysis patients. / Lund, Richard J.; Andress, Dennis L.; Amdahl, Michael; Williams, Laura A.; Heaney, Robert P.

In: American Journal of Nephrology, Vol. 31, No. 2, 02.2010, p. 165-170.

Research output: Contribution to journalArticle

Lund, Richard J. ; Andress, Dennis L. ; Amdahl, Michael ; Williams, Laura A. ; Heaney, Robert P. / Differential effects of paricalcitol and calcitriol on intestinal calcium absorption in hemodialysis patients. In: American Journal of Nephrology. 2010 ; Vol. 31, No. 2. pp. 165-170.
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abstract = "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.",
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