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Pulse versus daily oral Alfacalcidol treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized controlled trial

Authors Sawalmeh O, Moala S, Hamdan Z, Masri H, Ayoub K, Khazneh E, Shraim M

Received 24 August 2017

Accepted for publication 21 November 2017

Published 15 January 2018 Volume 2018:11 Pages 25—32


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Osama Sawalmeh,1 Shaheed Moala,1 Zakaria Hamdan,2 Huda Masri,3 Khubaib Ayoub,4 Emad Khazneh,2 Mujahed Shraim5

1Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 2Nephrology Department, 3Pharmacy Department, 4Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine; 5Public Health Department, College of Health Sciences, Qatar University, Doha, Qatar

Background: Secondary hyperparathyroidism is a common complication of chronic kidney disease and is managed using vitamin D replacement therapy. Very few studies have examined the effectiveness of pulse alfacalcidol therapy in comparison to daily oral alfacalcidol therapy in suppressing serum parathyroid hormone (PTH) levels in hemodialysis patients. The aim of this randomized controlled trial was to replicate the findings of prior studies comparing effectiveness of pulse oral alfacalcidol therapy versus daily oral alfacalcidol therapy in suppressing PTH after 13 weeks of therapy using a Palestinian sample of hemodialysis patients, and to identify demographic and biomedical characteristics of patients that are independently associated with PTH levels.
Methods: One hundred and sixty-seven patients completed the study, 88 in the daily group and 79 in the pulse group. The pulse group had more clinically significant reduction in mean PTH level by 75 pg/dL at 13 weeks than the daily group, but this was not statistically significant.
Results: The effect of alfacalcidol therapy on metabolism of phosphate and corrected calcium levels was comparable in both groups, and pulse therapy was not associated with increased risk of hypercalcemia and hyperphosphatemia. Serum PTH levels were independently and inversely associated with older age and diabetes.
Conclusion: Switching daily alfacalcidol therapy to thrice-weekly alfacalcidol pulse therapy seems safe and convenient, especially for hemodialysis patients with poor compliance with treatment. This study also highlights the importance of monitoring and preventing malnutrition in hemodialysis patients and maintaining optimal glycemic control in diabetic hemodialysis patients.

Keywords: end-stage kidney disease, hemodialysis, alfacalcidol, parathyroid hormone, hyperparathyroidism, randomized controlled trials, pulse therapy

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