Email updates

Keep up to date with the latest news and content from BMC Nephrology and BioMed Central.

Open Access Highly Accessed Research article

Comparison of oral and intravenous Alfacalcidol in chronic hemodialysis patients

Myriam Lessard, Denis Ouimet, Martine Leblanc, Annie-Claire Nadeau-Fredette, Robert Bell, Jean-Philippe Lafrance, Vincent Pichette and Michel Vallée*

Author Affiliations

Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l′Assomption, Montréal H1T 2 M4, Québec, Canada

For all author emails, please log on.

BMC Nephrology 2014, 15:27  doi:10.1186/1471-2369-15-27

Published: 4 February 2014

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords:
Alfacalcidol administration; End-stage renal failure; Hyperparathyroidism