[Advantage of intravenous pulse therapy with calcitriol or maxacalcitol in dialysis patients with renal hyperparathyroidism]

Abstract

In dialysis patients, deficiency of calcitriol down regulates vitamin D receptor (VDR) and decreases density of Ca sensing receptor, resulting right shift of set point of extra cellular Ca concentrations to release of parathyroid hormone. And then, renal hyperparathyroidism occurs and progresses. The purpose of pulse therapy with calcitriol or its analogue is elevating extra cellular calcitriol level up to supra physiological level, which up regulates VDR and shift the set point to left. The extra cellular calcitriol level after injection of calcitriol cannot compare with the level after oral administration of calcitriol at the same dose. The left shift of set point is investigated 4 weeks after intravenous pulse therapy with calcitriol or maxacalcitol, and degree of shift to the left depends on the single dose of these medicines. There is another advantage of intravenous pulse therapy, which takes no account of drug compliance or existence of malabsorption of lipid soluble vitamins.