Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients.
Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients.
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DOI：
10.1186/1471-2369-15-27
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发表时间：
2014-02-04
期刊：
影响因子：
2.3
通讯作者：
Vallée M
中科院分区：
文献类型：
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作者：
Lessard M;Ouimet D;Leblanc M;Nadeau-Fredette AC;Bell R;Lafrance JP;Pichette V;Vallée M
活化维生素 D 是治疗慢性血液透析患者继发性甲状旁腺功能亢进症 (SHPT) 的主要方法。然而，最佳给药途径仍存在争议。我们研究的目的是比较血液透析中口服阿法骨化醇与静脉注射（IV）阿法骨化醇的疗效。第二个目标是确定口服给药的成本效益优势。该研究纳入了 88 名慢性血液透析患者，每周 3 次静脉注射阿法骨化醇。在血液透析期间，所有患者均改用相同剂量的阿法骨化醇，每周口服 3 次。进行了预算影响分析。患者平均年龄为 64 岁，其中 43% 为男性。阿法骨化醇的平均剂量为每周 3 次，每次 2.1 微克。三个月后，血清甲状旁腺素 (PTH) 水平从 80 pmol/L 下降至 59 pmol/L (p = 0.001)，总血清钙水平从 2.34 mmol/L 上升至 2.40 mmol/L (p = 0.002)。六个月后，血清总钙水平仍然显着升高。研究期间阿法骨化醇剂量显着减少；每剂平均减少 0.44 μg。最后，口服给药每年可减少 197 678 美元的费用，每年减少 25 天的护理时间。我们的研究结果支持，在血液透析过程中将阿法骨化醇静脉注射改为口服给药，可能会通过较低剂量的活化维生素 D 实现类似的 SHPT 控制。这是优化依从性的良好策略，并且由于抑制 PTH 的功效更大，因此可能允许减少剂量。口服给药还具有显着的成本效益优势。
Activated vitamin D is the mainstay of treatment for secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients. However, the optimal route of administration is still debated. The aim of our study was to compare efficacy of oral vs intravenous (IV) administration of alfacalcidol in hemodialysis. A secondary objective was to determine the cost-effectiveness advantage of oral administration. Eighty-eight chronic hemodialysis patients receiving IV alfacalcidol three times a week were included in the study. All were switched to the same dose of alfacalcidol given orally three times a week during the hemodialysis session. A budget impact analysis was performed. Mean patient age was 64 years old and 43% were males. The mean alfacalcidol dose administered was 2.1 μg three times a week. After three months, serum parathormone (PTH) levels decreased from 80 to 59 pmol/L (p = 0.001) and total serum calcium levels increased from 2.34 to 2.40 mmol/L (p = 0.002). After six months, total serum calcium levels were still significantly higher. Alfacalcidol dosage was significantly decreased during study period; the mean reduction was 0.44 μg per dose. Finally, oral administration was associated with an annual cost reduction of 197 678$CAN and an annual nursing time reduction of 25 days. Our findings support that switching IV to oral administration of alfacalcidol during hemodialysis sessions may lead to a similar control of SHPT with lower doses of activated vitamin D. This is a good strategy for optimizing compliance and may allow a dose reduction because of a greater efficacy to suppress PTH. Oral administration also has significant cost-effectiveness advantages.
DOI：
10.1093/ndt/gfn264
发表时间：
2008-11
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
作者：
Taniguchi M;Tokumoto M;Tsuruya K;Hirakata H;Iida M
通讯作者：
Iida M