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ÇOCUK HEMODİYALİZ HASTALARINDA DİRENÇLİ SEKONDER HİPERPARATİROİDİZM TEDAVİSİNDE İNTRAVENÖZ KALSİTRİOL UYGULAMASI

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2000

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Intravenous calcitriol treatment in children with severe secondary hyperparathyroidism. The aim of this study is to assess the efficacy and safety of IV calcitriol treatment in the symptomatic children with secondary hyperparathyroidism (SHPT) who were found to bc nonresponsive to the standart oral calcitriol therapy. Fifteen children (8 boys, 7 girls) with a mcan age of 14.6 ± 3.4 years (range; 11-22 years) undergoİng hemodialysis were enrolled in this study. Ali patients hadreceived Standard oral preparation of calcitriol at a mean dosage of 1.0± 0.3 meg/day for at lcast onc ycar, and ali of tirem had serum intact parathyroid hormone (İPTH) İevels greater than 4 times normal values. After two wceks of wash-out period ali patients were treated with IV calcitriol (CALCIJEX -Abbott Laboratories) for 4 months in an open prospeetive study. The initial dose of calcitriol was 1 meg / three times per week (ie following each hemodialysis) follovved by a dosage modification every 4 weeks according to predialysis caleium (Ca), phosphorus (P) and İPTH ievels (maximum dose was 12 meg per week). Serum Ca, P, alkaline phosphatase (AP) İevels were monitored wcekly, and serum İPTH İevels werc determined monfhly during the study. Serum calcitriol and osteocalcin (OC) İevels were aîso determined at the beginning and at the end of the study. Ali of the 15 children completed their 4 months of IV calcitriol therapy. Symptoms substantially decreased wİthİn the 4th week of treatment and completely resolved by the end of 4th month. İPTH İevels slıowed a significant decrease from 799.5 ± 528.1 pg/ml to 144.2 ± 64.7 pg/ ml at the end of the study. This decrea-se was 78.9 % of baseline İPTH İevels at the fourth monfh. AP İevels decreased from 1454.0 ± 1044.2 IU/1 to 479.1 ± 200.4 IU/1 (p<0.01) in association with the decrease in İPTH. The me-an of basal calcitriol İevels was 20.5 + 3.6 ng/ml and changed to 27.6 ± 10.3 ng/ml (p< 0.05), but this inerease was not in toxic İevels. OC İevels showed a significant decrease from 27.3 ± 6.3 ng/ml to 23.9 ± 7.6 ng/ml, and it was corralated with the inerease of calcitriol İevels. No child in our study had symptoms to suggest adynamic bone disease Hypcrcalcemia was not a significant problem, and İPTH İevels showed an inerease to 244.7± 87.5 pg/ml at the third month after the discontinuation of IV calcitriol therapy. In conelusion, intermittent high dose IV calcitriol treatment İs an effectivc and safe method of PTH supression and relief of renal osteodystrophy (ROD) symptoms without inereasing hypercalcemia risk in the children undergoing hemodialysis wifh refractory SHPT, also provi-ding better patient compliance.
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Abstract (Original Language): 
Çalışmanın amacı; son dönem böbrek yetersizliği (SDBY) tanısı ile izlenen ve en az bir yıldır standart oral kalsitirİol tedavisi uygulandığı halde tedaviye dirençli bulunan, semptomatik, persistan sekonder hiperparatİroİdizmli (SHPT) hemodiyaliz tedavisindeki çocuklarda, IV in-termittan kalsitiriol uygulamasının etkinliği ve güvenilirliğinin değerlendirilmesidir. Çalışma grubu; yaş ortalaması 14.6 ± 3.4 yıl {1 î-22 yıl) olan 15 çocuk hastadan (8 erkek, 7 kız) oluştu. Olgularda, en az bir yıldır, 1.0 ± 0.3 meg/gün dozunda oral kalsitirİol kullanımına karşın, parat hormon (İPTH) düzeyieri normalin en az 4 katı yüksekti. Bazal kalsiyum (Ca), fosfor (P), alkali fosfataz (AP), İPTH, osteokalsin (OC), kalsitiriol düzeyleri İçin serum örneği alındıktan sonra, hastalara prospektif olarak dört ay süre iie IV kalsitirİol (CALCIJEX- Abbott Laboratuarı) uygulandı. Çalışma süresince, kalsitiriol doz ayarlaması, dört haftada bir, diyaliz öncesi Ca, P ve İPTH düzeylerine göre yapıldı. Maksimal doz 12 meg/ hafta olarak belirlendi. Dört aylık IV kalsitiriol tedavisinin sonunda olguların tümünde semptomlar düzelirken, İPTH düzeyleri 799.5 ± 528.1 pg/mî den, 144.2 ± 64.7 pg/ml' ye düştü (p<0.001). Bu azalma, bazal düzeye göre 4.ayda %78.9 oranında idi. AP düzeyleri, tedavi başlangıcında 1454.0 ± 1044.2 lU/It idi ve başlangıçta ağır SHPT grubunda yer alan 2 olgu (olgu: 8 vc 11) dışında normal sınırlara inerek tedavinin sonunda 479.1 ± 200.4 IU/lt olarak saptandı (p< 0.001). Tedavi başlangıcında kalsitiriol düzeyi 20.5+3.6 ng/ml iken, tedavi sonunda 27.6+10.3 ng/ml' ye yükseldi (p<0.05). Bir olgu dışında fizyolojik değerlerin üzerine çıkmadı. Tedavi başlangıcında, hemodiyaliz öncesi alınan serum örneklerinde OC düzeyi 27.3+6.3 ng/ml idi ve 4 aylık kalsitiriol tedavisinin sonunda 23.8+7.6 ng/ml' ye düştü. Çalışma süresince hiçbir olguda ağır hiper-kalscmi atağı olmadı, tedavi kesildikten sonraki kontrollerde olgularda adinamik kemik hastalığı düşündüren bulgu saptanmadı. Sonuç olarak IV intermittan kalsitiriol tedavisinin çocuklarda iyi tolere edilen ve ilaç uyumu sorununu ortadan kaldıran, ve dirençli SHPT gelişmiş çocuk hemodiyaliz hastalarında hiper-kalsemİ riskinde artışa neden olmadan İPTH baskılanmasın! sağlayan etkin ve güvenilir bir tedavi olduğunu düşünmekteyiz.
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  • 1
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  • Turkish

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