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2015 ; 26
(5
): 1205-14
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Paricalcitol for secondary hyperparathyroidism in renal transplantation
#MMPMID25194004
Trillini M
; Cortinovis M
; Ruggenenti P
; Reyes Loaeza J
; Courville K
; Ferrer-Siles C
; Prandini S
; Gaspari F
; Cannata A
; Villa A
; Perna A
; Gotti E
; Caruso MR
; Martinetti D
; Remuzzi G
; Perico N
J Am Soc Nephrol
2015[May]; 26
(5
): 1205-14
PMID25194004
show ga
Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone
disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum
parathyroid hormone levels and proteinuria in patients with secondary
hyperparathyroidism. This single-center, prospective, randomized, crossover,
open-label study compared the effect of 6-month treatment with paricalcitol (1
?g/d for 3 months and then uptitrated to 2 µg/d if tolerated) or nonparicalcitol
therapy on serum parathyroid hormone levels (primary outcome), mineral
metabolism, and proteinuria in 43 consenting recipients of renal transplants with
secondary hyperparathyroidism. Participants were randomized 1:1 according to a
computer-generated sequence. Compared with baseline, median (interquartile range)
serum parathyroid hormone levels significantly declined on paricalcitol from
115.6 (94.8-152.0) to 63.3 (52.0-79.7) pg/ml (P<0.001) but not on nonparicalcitol
therapy. At 6 months, levels significantly differed between treatments (P<0.001
by analysis of covariance). Serum bone-specific alkaline phosphatase and
osteocalcin decreased on paricalcitol therapy only and significantly differed
between treatments at 6 months (P<0.001 for all comparisons). At 6 months,
urinary deoxypyridinoline-to-creatinine ratio and 24-hour proteinuria level
decreased only on paricalcitol (P<0.05). L3 and L4 vertebral mineral bone
density, assessed by dual-energy x-ray absorption, significantly improved with
paricalcitol at 6 months (P<0.05 for both densities). Paricalcitol was well
tolerated. Overall, 6-month paricalcitol supplementation reduced parathyroid
hormone levels and proteinuria, attenuated bone remodeling and mineral loss, and
reduced eGFR in renal transplant recipients with secondary hyperparathyroidism.
Long-term studies are needed to monitor directly measured GFR, ensure that the
bone remodeling and mineral effects are sustained, and determine if the reduction
in proteinuria improves renal and cardiovascular outcomes.
|*Kidney Transplantation
[MESH]
|Adult
[MESH]
|Bone Density Conservation Agents/pharmacology/*therapeutic use
[MESH]
|Bone Density/drug effects
[MESH]
|Bone Remodeling/drug effects
[MESH]
|Calcium/blood
[MESH]
|Creatinine/blood
[MESH]
|Cross-Over Studies
[MESH]
|Ergocalciferols/pharmacology/*therapeutic use
[MESH]
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