Switching from intravenous (IV) to oral activated vitamin D may offer similar control of secondary hyperparathyroidism in patients on chronic hemodialysis (HD) with lower doses of the drug, according to a new Canadian study.
The study, led by Michel Vallée, MD, of Hôpital Maisonneuve-Rosemont in Montreal, included 88 chronic HD patients receiving IV alfacalcidol three times a week. Investigators switched the patients to the same dose of alfacalcidol given orally three times a week during HD sessions. The mean alfacalcidol dose administered was 2.1 ug three times a week.
After three months, serum parathyroid hormone (PTH) levels decreased significantly from 80 to 59 pmol/L and total serum calcium levels increased significantly from 2.34 to 2.40 mmol/L, the researchers reported in BMC Nephrology (2014;15:27). In addition, the alfacalcidol dosage was significantly decreased during the study period, with a mean reduction of 0.44 ug per dose. Oral administration of the medication was associated with an annual cost reduction of $197,678 in Canadian dollars ($178,305 U.S.) and annual nursing time reduction of 25 days.
“To our knowledge, this is the first study to show such findings,” the researchers noted.
They concluded that their findings suggest that intermittent oral administration of alfacalcidol is even more effective than an equivalent IV dosage with respect to suppressing PTH.
“For maintaining serum PTH levels within target limits or for compliance purposes, intermittent oral administration of alfacalcidol in an HD unit is a much more cost-effective strategy [than IV administration],” the authors wrote.