Korean Journal of Nephrology 1996;15(3):384-391.

이차성 부갑상선 기능 항진증이 있는 만성 혈액 투석 환자에서 정주 칼시트라이롱의 투여와 골밀도의 증가

윤성노 , 양철우 , 김석영 , 최의진 , 장윤식 , 방병기

Abstract

Secondary hyperparathyroidism is common in ch- ronic renal failure(CRF) and is due to hypocalcemia and inadequate synthesis of calcitriol. We evaluated the effect of 6months treatment with intravenous calcitriol on PTH levels and bone mineral density (BMD). 11 hemodialysis patients with the elevated 1,84-intact PTH(>150pg/ml) were randomly divided into two groups,' the thrice weeldy administration of 2Mlg calcitriol (6 patients) and the once weekly admi- nistration of 3mg (5 patients). The patients were dialysed with conventional bicarbonate dialysate. The 1,84-intact PTH(iPTH) and the alkaline phosphatase were measured monthly. The bone mineral density(BMD) was measured before and after this study by dual energy X-ray absorptiometry(DEXA). The results were as follows: 1) The iPTH was decreased by 32.6±20.4% and 9.7±3.2% of baseline value in the thrice weekly group, 50.2±24.7% and 57.7±26.8% in the once weeldy group after 3 and 6months, respectively. The iPTH in the thrice weeldy group showed the decreasing tendency over time (p=0,034) compared with that in the once weekly group (p>0.1). 2) The alkaline phosphatase was decreased by 85.3±35.4% and 54.1±18.5% of baseline value in the thrice weekly group, 90.9±13.8% and 80.2±15.7% in the once weekly group after 3 and 6months, res- pectively. The alkaline phosphatase in the thrice weekly group showed the decreasing tendency over time (p=0.0001) compared with that in the once weekly group(p>0.1). 3) Lumbar spine (p=0,036), femoral neck (p=0.015) and trochanter BMD (p=0.028) were significantly in- creased in the thrice weekly gmup. The once weekly group did not show the significant changes in BMD. 4) Serum calcium and phosphate were increased in both groups as time went on. After 6months, serum calcium was more increased in the thrice weekly group (1.81±0.37mg/dl/6month) than in the once weekly group(0.98±0.52mg/dl/6month)(p=0.012). In conclusion, iPTH suppression witb intravenous administration of 2mg calcitriol in the thrice weekly group is more effective than that with 3mg in the once weekly group. It is suggested that the effective 6months therapy with calcitriol would result in the increased BMD in CRF patients with secondary hyperparathyroidism.