Intermittent or daily administration of 1-alpha calcidol for nephrectomised infants on peritoneal dialysis?

Pediatr Nephrol. 2007 Nov;22(11):1931-8. doi: 10.1007/s00467-007-0592-1. Epub 2007 Sep 13.

Abstract

Secondary hyperparathyroidism and renal osteodystrophy are major problems in patients with end-stage renal failure and may result in poor growth in children on dialysis. Whether vitamin D sterols should be given intermittently or daily remains a controversial issue. We studied 16 bilaterally nephrectomised infants with congenital nephrosis of the Finnish type (median age 0.54 years), all on peritoneal dialysis. Nine of them were receiving intermittent 1-alpha calcidol therapy and seven daily 1-alpha calcidol therapy. The target serum parathyroid hormone (PTH) level was 2-3 times the upper limit of normal (ULN). There were no statistically significant differences in PTH values between the groups (1.7-times vs 0.5-times the ULN at 3 months and 3.1-times vs 3.4-times the ULN at 6 months, respectively). The required weekly doses of 1-alpha calcidol were low, and there were no significant differences between the intermittent and daily groups (0.06 microg/kg vs 0.04 microg/kg at 3 months and 0.09 microg/kg vs 0.05 microg/kg at 6 months, respectively). The infants on intermittent 1-alpha calcidol showed significant catch-up growth during dialysis after nephrectomy relative to the infants on daily 1-alpha calcidol (-1.6 SD to -0.7 SD vs -1.4 SD to -1.0 SD, respectively; P < 0.05). Our results indicate that either intermittent or daily vitamin D analogue therapy, if started early, will prevent secondary hyperparathyroidism equally well in children on peritoneal dialysis (PD), but intermittent therapy might be more favourable for growth.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Density Conservation Agents / administration & dosage*
  • Child Development
  • Chronic Kidney Disease-Mineral and Bone Disorder / drug therapy*
  • Chronic Kidney Disease-Mineral and Bone Disorder / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxycholecalciferols / administration & dosage*
  • Hyperalgesia / drug therapy*
  • Hyperalgesia / etiology
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / surgery
  • Kidney Failure, Chronic / therapy
  • Male
  • Nephrectomy
  • Nephrosis / complications*
  • Nephrosis / congenital
  • Nephrosis / surgery
  • Parathyroid Hormone / blood
  • Peritoneal Dialysis
  • Retrospective Studies

Substances

  • Bone Density Conservation Agents
  • Hydroxycholecalciferols
  • Parathyroid Hormone
  • alfacalcidol