Alfacalcidol Vs. Calcidol for Secondary Hyperparathyroidism

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points
  • Oral alfacalcidol is effective in controlling secondary hyperparathyroidism with an adjusted dose 1.5 times that of oral calcitriol.
  • PTH levels at 24 weeks were 302 pg/mL and 312 pg/mL in the calcitriol and alfacalcidol groups, respectively, a nonsignificant difference between the groups.
  • Differences in serum calcium and serum phosphorus levels and calcium-phosphate product between calcitriol and alfacalcidol groups were also nonsignificant.

Oral alfacalcidol is effective in controlling secondary hyperparathyroidism with an adjusted dose 1.5 times that of oral calcitriol, a study showed.

In a randomized, single-blinded controlled trial, researchers in Thailand studied 32 hemodialysis patients with secondary hyperparathyroidism whom they stratified according to HD frequency and parathyroid hormone (PTH) levels and randomized to receive either calcitriol or alfacalcidol in a dose-escalating fashion for up to 24 weeks.

At baseline, the two groups were similar with respect to serum calcium, phosphorus, and PTH levels. PTH levels at 24 weeks were 302 pg/mL and 312 pg/mL in the calcitriol and alfacalcidol groups, respectively, a nonsignificant difference between the groups.

The proportion of patients who achieved the PTH target (less than 300 pg/mL) increased progressively from the start to the end of treatment (to 82% for calcitriol-treated patients and 67% for alfacalcidol recipients), also a nonsignificant difference between the groups.

Serum calcium levels for the calcitriol and alfacalcidol groups were 9.3 and 9.4 mg/dL, respectively; serum phosphorus levels were 5.0 and 5.4 mg/dL; calcium-phosphate product was 53.7 and 59.9 mg2/dL2. None of these differences was significant. The mean dose of the drugs was 4.4 μg/week for calcitriol and 6 μg/week for alfacalcidol.

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