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1alpha(OH)D3 One-alpha-hydroxy-cholecalciferol--an active vitamin D analog. Clinical studies on prophylaxis and treatment of secondary hyperparathyroidism in uremic patients on chronic dialysis.

Author: BrandiLisbet

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Overview

Chronic uremia is characterized by decreased plasma 1,25(OH)2D3 levels due to reduced renal 1-hydroxylase activity and decreased renal phosphate excretion. This leads to secondary hyperparathyroidism due to low plasma calcium and 1,25(OH)2D3 levels and high phosphate levels. Secondary hyperparathyroidism is linked to increased mortality and cardiovascular calcifications in chronic uremic patients. Treatment focuses on preventing hyperphosphatemia with oral phosphate binders and replacing the reduced renal hydroxylation with 1 alpha-hydroxylated vitamin D analogs. This thesis explores the effects of 1alpha(OH)D3 treatment in chronic dialysis patients, focusing on its ability to suppress plasma PTH levels without causing hypercalcemia. The study found that intravenous administration of 1alpha(OH)D3 effectively suppressed plasma PTH levels in patients on chronic hemodialysis without causing serious side effects, and hypercalcemia could be prevented by monitoring plasma Ca 2+ levels and adjusting 1alpha(OH)D3 doses accordingly. Long-term intermittent intravenous treatment with 1alpha(OH)D3 effectively suppressed plasma intact PTH levels. When plasma intact PTH was suppressed to a stable level with intravenous 1alpha(OH)D3, the suppression could be maintained by intermittent oral 1alpha(OH)D3 therapy. The study also investigated the effects of a treatment modality combining 1alpha(OH)D3 and CaCO3 as phosphate binders with reduced calcium concentration in dialysis fluid to prevent hypercalcemia. The combination prevented the development of secondary hyperparathyroidism in patients with normal PTH levels and suppressed PTH levels in patients with secondary hyperparathyroidism. No signs of adynamic bone disease were observed. Intravenous 1alpha(OH)D3 prevented bone mineral density (BMD) decrease in the lumbar spine and femoral neck of hemodialysis patients. The study also examined the pharmacokinetic differences between intravenous and oral administration of 1,25(OH)2D3 and 1alpha(OH)D3 and their acute effects on plasma PTH, Ca 2+, and phosphate levels.
Paper Details　
Original Abstract of the Article :
Chronic uremia is characterized by decreased levels of plasma 1,25(OH)2D3 due to decreased renal 1-hydroxylase activity and by decreased renal phosphate excretion. The consequence is an increased synthesis and secretion of parathyroid hormone--secondary hyperparathyroidism--due to the low levels of ...See full text at original site
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引用元：
https://pubmed.ncbi.nlm.nih.gov/19232159

データ提供：米国国立医学図書館（NLM）

The Vitamin D3 Dilemma: A Balancing Act for Kidney Patients

This study delves into the world of kidney disease, specifically secondary hyperparathyroidism, which is characterized by an overproduction of parathyroid hormone (PTH). Imagine PTH as a conductor of a symphony orchestra, but in this case, it's conducting a symphony of bone loss and calcium imbalance. Chronic kidney disease patients face the challenge of maintaining healthy bone mineral density due to their compromised kidney function. The researchers investigated the use of 1alpha(OH)D3, a vitamin D analog, to control PTH levels and prevent bone complications in these patients.

A Vitamin D Balancing Act

The study involved a series of trials where patients on dialysis received various doses of 1alpha(OH)D3. The researchers discovered that intravenous administration of 1alpha(OH)D3 effectively suppressed PTH levels, preventing bone loss and complications, much like a skilled conductor keeping the orchestra in perfect harmony. The results also showed that oral administration of 1alpha(OH)D3 could maintain PTH suppression. This finding is significant because it offers a less invasive and more convenient treatment option for patients.

Preventing Hypercalcemia: Finding the Right Dose

While 1alpha(OH)D3 is beneficial in controlling PTH levels, it can also lead to hypercalcemia, or an excess of calcium in the blood. Imagine a calcium surplus as a sandstorm in your body - too much and it can be harmful. The researchers carefully monitored calcium levels and adjusted the dosage of 1alpha(OH)D3 to prevent hypercalcemia. This highlights the importance of personalized medicine and tailoring treatment to each patient's individual needs.

Dr.Camel's Conclusion

This research provides valuable insights into the use of 1alpha(OH)D3 in managing secondary hyperparathyroidism in kidney patients. It's a reminder that finding the right balance is crucial, especially when it comes to managing complex medical conditions. It's not just about the right drug, but also the right dose and the right approach for each individual.

Date :
  1. Date Completed 2009-04-23
  2. Date Revised 2013-11-21
Further Info :

Pubmed ID

19232159

DOI: Digital Object Identifier

DMB4040

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Languages

English

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