Different treatments for secondary hyperparathyroidism of end-stage renal disease

Objective To observe and evaluate the efficacy and safety of calcitriol pulse therapy (CPT) and routine therapy for patients with secondary hyperparathyroidism (SHPT) of end-stage renal disease (ESRD).Methods 28 patients with SHPT (iPTH 500 ～ 1000 pg/ml) of ESRD undergoing maintenance hemodialysis (MHD) were randomly divided into two groups:calcitriol pulse therapy group and routine therapy group (control group),14 patients for each group.The patients in the calcitriol pulse therapy group was treated with 2 ～ 4 μ g Calcitriol Soft Capsules per time,twice a week,while the patients in the routine therapy group was treated with 0.25 p g Calcitriol Soft Capsules daily.All patients were treated with Calcitriol Soft Capsules for 12 weeks after receiving hemodialysis.The improvement in symptoms,changes in levels of iPTH,Ca2+,p3-,and AKP,and adverse reactions of both groups were observed.Results The patients in the calcitriol pulse therapy group had obvious improvement in skin pruritus,bone pain,and fatigue.The level of iPTH decreased from (756.5 ± 198.2) pg/ml before the treatment to (415.2 ± 158.8) pg/ml after the treatment.The level of p3-decreased from (2.12 ± 0.32) mmol/L before the treatment to (1.12 ± 0.38) mmol/L after the treatment.The level of AKP decreased from (141.2 ± 39.1) U/L before the treatment to (108.5 ± 31.6) U/L after the treatment.The levels of iPTH,P3-and AKP decreased apparently,while the level of Ca2+ increased from (1.88 ± 0.15) mmol/L before the treatment to (2.42 ± 0.22) mmol/L after the treatment.But there were no hypercalcemia and serious adverse reactions.The differences are notable and have statistical significances (P ＜ 0.01).However the patients in the routine therapy group didn' t have obvious improvement in symptoms.The levels of iPTH,p3-,AKP,and Ca2+ didn' t change obviously.The differences didn' t have statistical significances (P ＞ 0.05).Conclusion Calcitriol pulse therapy is obviously more effective than routine therapy in treating patients with SHPT of ESRD undergoing maintenance hemodialysis and has high safety and patient compliance. Key words: Calcitriol;  End-stage renal disease (ESRD);  Hemodialysis;  Secondary hyperparathyroidism (SHPT);  Intact parathyroid hormone (iPTH)