Abstract:

Background. The impetus to develop percutaneous calcitriol injection therapy (PCIT) was the lack of therapeutic tools to treat secondary hyperparathyroidism (2HPT) resistant to medical therapy.

Methods. Nine dialysis patients resistant to intravenous calcitriol or calcitriol analogues underwent daily PCIT 5–10 times consecutively. The PCIT involved the injection of a volume of calcitriol equal to that of the enlarged parathyroid glands (PTGs) under ultrasonographic guidance. All patients had follow-up intravenous calcitriol after PCIT.

Results. The serum intact PTH concentration was markedly reduced following PCIT and was maintained for 12 weeks with intravenous calcitriol without significant changes in serum adjusted calcium and phosphorus concentrations. All patients tolerated PCIT without serious adverse events. Serum bone alkaline phosphatase concentrations and the volume of the enlarged PTGs were also significantly reduced.

Conclusion. PCIT is a safe and effective treatment, which may also suppress parathyroid hyperplasia and improve bone turnover for refractory 2HPT.

Keywords: calcitriol; end-stage renal disease (ESRD); interventional ultrasonography; renal osteodystrophy; secondary hyperparathyroidism

Document Type: Research article

DOI: 10.1093/ndt/gfg1011

Affiliations: 1: Center of Blood Purification Therapy and 2: The First Department of Pathology, Wakayama Medical University, Wakayama, Japan