Cholecalciferol versus calcitriol to manage secondary hyperparathyroidism in hemodialysis patients

Abstract

Introduction: Secondary hyperparathyroidism, is a matter of concern in hemodialysis patients that cause renal osteodystrophy eventually. Objectives: The objective of the study was to compare the efficacy of cholecalciferol with calcitriol for treating secondary hyperparathyroidism. Materials and Methods: This study is a randomized, controlled study. Around 80 patients with hyperparathyroidism (PTH >300 ρg/ mL) and 25(OH)D level <20 ng/mL were divided into two groups to receive cholecalciferol 50 000 IU/3 times in one week or calcitriol 0.25 μg/daily for 12 weeks. Additionally calcium carbonate 1000-1500 mg/d/tablets is prescribed for both groups. Reduction of parathyroid hormone (PTH), changes of plasma albumin-corrected calcium and phosphorus and levels of 25(OH)D were analyzed. Results: Around 40 patients were randomized into each group. At baseline, plasma albumin-corrected calcium, phosphorus and intact PTH and 25(OH)D had no difference between groups. At week 12, intact PTH levels in cholecalciferol and calcitriol groups were 242.38±16.38 ρg/mL and 237.84±13.65 ρg/mL in respectively. Patients who achieved target intact PTH of <300 ρg/mL were 90% in the cholecalciferol and 95% in the calcitriol group (P = 0.447). Serum calcium and phosphorus were not significantly different in both groups. Serum calcium; 9.07±0.36 mg/dL versus 9.00 ± 0.38 mg/dL (P = 0.607), phosphorus; 4.81±0.55 mg/dL versus 4.15 ± 0.42 mg/dL (P = 0.126) in cholecalciferol and calcitriol groups respectively. Furthermore, serum 25(OH)D levels significantly rise in cholecalciferol group. Serum 25(OH)D levels were 62.98 ±21.03 ng/mL in cholecalciferol group and 18.95±22.70 ng/mL in calcitriol group (P < 0.05). Conclusion: cholecalciferol can be administered to control secondary hyperparathyroidism and vitamin D(25OH) deficiency in hemodialysis patients . The two drugs are equally efficacious and lead to similar changes in calcium and phosphorus levels.