Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

  • Mansoor Abbas Qaisar Nepgrologist
  • Zain ul Abideen
  • Fateh Sher Chattah
  • Muhammad Nadeem
  • Zahid Hafeez
Keywords: Alfacalcidol, Paricalcitol, Secondary hyperparathyroidism, Hemodialysis.

Abstract

ABSTRACT

 

Objective of study: To Compare the efficacy of Alfacalcidol (I.V) and Paricalcitol (I.V) for the treatment of secondary hyperparathyroidism  (SHPT)  in hemodialysis patients.

Materials and Methods: An open-label randomized clinical trial  carried out to compare the efficacy of intravenous paricalcitol and alfacalcidol. We recruited 80 patients with end stage renal  disease receiving  maintenance hemodialysis in a tertiary care hospital dialysis unit. The participants were randomly divided into two  groups. A wash out period of one week was decided for each patient in which he/she did not receive any medication for treatment of hypocalcemia, hyperphosphatemia or secondary hyperparathyroidism. Afterwards, patients  received  expanding dosage of alfacalcidol or paricalcitol  for a time of about four months and then after a further wash out period of one week, each group received  opposite treatment (paricalcitol or alfacalcidol) for further  four months (16 weeks).

Results: The analyzed data for the same end points revealed no difference between the two groups. No significant statistical difference in terms of  calcium levels in both groups was noted. The study also found no big difference  in the ability of both drugs to treat secondary hyperparathyroidism, while keeping serum phosphate and calcium levels inside the desired range. The study also found no distinction in the frequency of hypercalcemia and  hyperphosphatemia as a side effect of Vitamin D analogue’s treatment.

 

Conclusion: The study concludes that alfacalcidol and paricalcitol are equally effective in treatment of secondary hyperparathyroidism in dialysis population. Since Paricalcitol is expensive as compared to alfacalcidol, in an economically challenged country like Pakistan, Alfacalcidol can be a better  choice when treating SHPT as we did not  find any gross difference in the ability of two drugs to restrict SHPT.

 

Keywords:  Alfacalcidol, Paricalcitol, Secondary hyperparathyroidism, Hemodialysis.

References

REFERENCES:
1. Lavinia Negrea. Active Vitamin D in Chronic Kidney Disease: Getting Right Back Where We Started from?: Kidney Dis (Basel). 2019 Mar 5; (2):59-68
2. Geoffrey A. Block, Preston S. Klassen, J. Michael Lazarus, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–2218.
3. Stuart M Sprague , Francisco Llach, Michael Amdahl, et al. Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int. 2003 April;63(4):1483–1490.
4. Alex J Brown, Jane Finch, Eduardo Slatopolsky. Differential effects of 19-nor-1,25-dihydroxyvitamin D(2) and 1,25-dihydroxyvitamin D(3) on intestinal calcium and phosphate transport. J Lab Clin Med. 2002 May;139(5):279–284.
5. Lavinia Negrea. Active Vitamin D in Chronic Kidney Disease: Getting Right Back Where We Started from?: Kidney Dis (Basel). 2019 Mar 5; (2):59-68
6. Ditte Hansen, Lisbet Brandi, Knud Rasmussen, et al. Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol: BMC Nephrol. 2009 Sep 24;10(28)

7.The Danish Society of Nephrology. Danish National Registry Annual Report. 2007. http://www.nephrology.dk [CrossRef] [Ref list]
8. Xinghua Geng, Ermin Shi, Shiwei Wang, et al. A comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials: PLoS One. 2020 May 29;15(5):e0233705
9. Daniel W Coyne, Seth Goldberg, Mark Faber, et al. A randomized multicenter trial of paricalcitol versus calcitriol for secondary hyperparathyroidism in stages 3-4 CKD: Clin J Am Soc Nephrol.2014 Sep 5; 9(9):1620-6
10. Yang Liu, Ling-Yun Liu, Ye Jia, et al. Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis: Drug Des Devel Ther.2019 Mar;28(13):999-1009
11. Yifeng Xie, Peiling Su, Yifan Sun, et al. Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials: BMC Nephrol.2017 Aug 25;18(1):272
12. Panpan Cai, Xiaohong Tang, Wei Qin, et al. Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials: Int Urol Nephrol .2016 Apr;48 (4):571-84
Published
2020-12-30
How to Cite
1.
Qaisar M, Abideen Z, Chattah F, Nadeem M, Hafeez Z. Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients. JRMC [Internet]. 30Dec.2020 [cited 25Sep.2021];24(4):378-83. Available from: https://journalrmc.com/index.php/JRMC/article/view/1468