Intraperitoneal Calcitriol in Infants on Peritoneal Dialysis

Abstract

Background Calcitriol has long been used as the main therapy in renal osteodystrophy, but the efficacy of the oral route is not always as high as expected. Objective To asses the safety and efficacy of intraperitoneal calcitriol in infants undergoing peritoneal dialysis (PD). Patients and Methods PD patients on oral calcitriol therapy, with serum parathyroid hormone (PTH) >1000 pg/mL during the previous 3 months of treatment, were switched to intraperitoneal calcitriol therapy, 1 μg twice per week. Dose was increased to 1 μg three times per week if PTH remained >1000 pg/mL, and was later readjusted. Target PTH was 200 – 300 pg/mL according DOQI guidelines. Statistics: All results are expressed as mean ± SE. The Wilcoxon signed rank test was used to evaluate differences in measurements for each pair of values. The confidence interval for differences between population medians was 96.9%. A p value less than 0.05 was considered significant. Results Six male children, mean age 17 ± 3.86 months, completed a 12-month follow-up. Mean pretreatment PTH was 1654 ± 209 pg/mL. Mean PTH at months 0, 3, 6, 9, and 12 was 1448 ± 439*, 1277 ± 723, 910 ± 704, 582 ± 282*, and 465 ± 224* pg/mL, respectively (*p < 0.05). Twelve hypercalcemic and 10 hyperphosphatemic episodes were successfully treated. Conclusion Infants on PD who fail to respond to oral calcitriol therapy can be safely treated with intraperitoneal administration of active vitamin D.

Intraperitoneal Calcitriol for Treatment of Severe Hyperparathyroidism in Children with Chronic Kidney Disease: A Therapy Forgotten

“…The IP group demonstrated higher calcium levels, a significant reduction in PTH, and lower serum phosphorus levels than the oral group (2). The efficacy of IP calcitriol has also been confirmed in infants on PD (8). None of these studies reported any major side effects related to IP calcitriol administration.…”

Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2–5 and on dialysis

“…In a prospective uncontrolled trial, six children not responding to oral calcitriol treatment for >12 months were given intraperitoneal calcitriol and showed a significant decrease in PTH levels after 9 months, but also significantly more episodes of hypercalcaemia and hyperphosphataemia on intraperitoneal treatment [53]. Calcitriol is no longer licensed for intraperitoneal use.…”

Vitamin D Therapy in Children on Dialysis

“…In this issue of Peritoneal Dialysis International , Cano et al report the use of the intravenous form of calcitriol (Calcijex, 1 μg/mL; Abbott Laboratories, Abbott Park, Illinois, USA) given intraperitoneally to a cohort of infants undergoing PD with persistent 2°HPT despite conventional therapy with oral doses of calcitriol (3). Patients entering the study had serum parathyroid hormone (PTH) levels >1000 pg/mL despite treatment with oral calcitriol therapy (0.01 – 0.05 μg/kg/day) and calcium-based binders for at least 1 year.…”