이차성 부갑상선 기능 항진증이 있는 지속성 외래 복막투석 환자에서 칼시트리올 경구 충격요법과 저용량 매일 요법의 비교연구

Abstract

The most widely used method for treatment of secondary hyperparathyroidism(SH) in CAPD patients has been the administration of calcitriol by oral route. In this study, we compared the efficacy and safety of daily low dose calcitriol therapy with those of intermittent high dose pulse therapy. The study group consisted of 38 patients undergoing CAPD with serum intact PTH level of more than 200pg/mL. Twenty patients were randomly administered daily low dose calcitriol(0.25㎍/day for 1 month followed by 0.5㎍ daily dose for the next 3 months) while 18 patients were given intermittent pulse therapy(0.5㎍-0.5㎍-0.75㎍ 3 times a week for 1 month, increased to 1.0㎍-1.25㎍ 3 times a week for the next 3 months). Thirty five patients completed the study : 17 on daily oral calcitriol (M : F=0.7 : 1, mean age=47.3±10.6 years, mean duration of CAPD=48.9±41.1 months), and 18 on oral pulse calcitriol(M : F=1.6 : 1, mean age=41.5±12.7 years, mean duration of CAPD=49.2±41.6 months). The baseline serum levels of calcium, phosphorus, i-PTH, alkaline phosphotase, and total CO2 were not different between daily and pulse group(9.5±0.8 vs 9.3±0.9 ㎎/dL, 5.8±1.3 vs 5.1±1.2㎎/dL, 443.1±162.5 vs 546.±385.9pg/mL, 91.8±47.7 vs 108.9± 66.5IU/L, 23.7±1.9 vs 25.5±2.0mEq/L, p>0.05, respectively). The i-PTH level decreased significantly in daily calcitriol group after 1 month(332.8±214.8pg/mL, p<0.01), and at final evaluation(180±254.8pg/mL, p<0.01). In pulse calcitriol group, i-PTH level also decreased significantly to 400.4±225.8pg/mL(p<0.05), 89.4±122.6 pg/mL(p<0.01), respectively. The rate of decline in i-PTH level from baseline were similar(daily=25.4± 22.7 vs pulse=19.5±12.6%decline.month, p>0.05). The serum calcium increased similarly in both groups after treatment(daily=10.6±0.8 vs pulse=10.1±1.0㎎/dL, p>0.05). Hypercalcemia(>11.0㎎/dL) was rarely observed in all patients(daily=5, pulse=8 episodes). In conclusion, both daily and pulse calcitriol therapy were similarly effective and safe in control of SH.