Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Data comparing the efficacy of alfacalcidol versus calcitriol in managing secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is scarce
Research Question or Hypothesis: Which drug is more effective in managing hyperparathyroidism in patients with CKD stage 3 to 5?
Study Design: A retrospecitve observational cohort study.
Methods: The study, conducted from January to December 2022, included adults with CKD stages 3 to 5 who received alfacalcidol for 3 months followed by calcitriol for another 3 months. Assessments were done at baseline, after 3 months of each treatment. The primary outcome was iPTH suppression, and the secondary outcome was total serum calcium levels.
Results: A total of 70 patients were included in the analysis. The cohort's mean age was 65.5±15 years, mean body mass index was 31.8±6.6 kg/m2, and 34 (48.6%) were males. CKD stage 3 comprised 47.1% of the sample. The median dose of alfacalcidol was 0.5 (0.25-0.8) mcg, compared to 0.5 (0.25-0.5) mcg for calcitriol (p=0.001). Alfacalcidol did not significantly suppress iPTH levels, with median values of 13.31 (8.23-24.4) pg/mL at baseline and 12.5 (8.86-24.7) pg/mL after 3 months (p=0.937). In contrast, calcitriol significantly reduced iPTH levels from 12.5 (8.86-24.7) pg/mL to 10.7 (5.7-19) pg/mL (p=0.017). Additionally, alfacalcidol did not significantly increase calcium levels, with values of 2.29 (2.2-2.3) mmol/L at baseline and 2.3 (2.23-2.36) mmol/L after 3 months (p=0.237), whereas calcitriol significantly increased calcium levels from 2.3 (2.23-2.36) mmol/L to 2.34 (2.27-2.43) mmol/L (p=0.001). Throughout the study period, albumin values, follow-up times, and the use of phosphate binders or non-active vitamin D remained consistent for each drug.
Conclusion: Calcitriol, at significantly lower doses, was more effective than alfacalcidol in reducing iPTH levels and increasing calcium levels over 3 months. Larger prospective controlled studies are needed to confirm these findings.
Presenting Author
Wasim Elnekidy PharmD, BCPS, BCACPCleveland Clinic Abu Dhabi
Authors
Emna Abidi PhD
Cleveland Clinic Abu Dhabi
Iyad Ghazal BSc Pharm
College of Pharmacy, Gulf Medical university, Ajman, United Arab Emirates
Muriel Ghosn MD
Cleveland Clinic Abu Dhabi
Fadi Hijazi MD
Cleveland Clinic Abu Dhabi
Rakesh Madhyastha MD
Cleveland Clinic Abu Dhabi
Amir Malik MD
Cleveland Clinic Abu Dhabi
Jihad Mallat MD
Cleveland Clinic Abu Dhabi