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Thread: calcitriol

  1. #1
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    Default calcitriol

    What are the maximum levels (pth, Ca, etc.) that calcitriol should be given?

    Should all the new research showing the health benefits of Vitamin D be taken into account or should we only be concerned with calcium/phosphorus regulation?
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  2. #2
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    The K/DOQI Guideline on bone disease which is based on research as well as experts' opinions includes recommendations for when to administer (and stop) Vitamin D according to levels of PTH (>300 g/mL), calcium (<9.5 mg/dL) and phosphorus (<5.5 mg/dL), how to administer, how to monitor, when to reduce the dose, how to treat PD vs. HD patients. It uses algorithms (decision trees) to help doctors decide when to give, hold, or stop Vitamin D therapy.

    The guideline recommends topics for future research. There are separate guidelines for adults and children. This link is to the guideline for adults with kidney failure.
    http://www.kidney.org/professionals/...ne/Guide8B.htm

    One thing to remember when you read about recommended treatments is that studies often exclude people that have kidney problems. When you have kidney failure or even kidney damage, the side effects of the drugs may be harmful. In fact, according to this guideline:

    A major side-effect of vitamin D treatment is increased intestinal absorption of calcium and phosphorus; this can produce hypercalcemia and aggravate hyperphosphatemia. Treatment with active vitamin D sterols can also markedly lower serum levels of intact PTH and reduce bone formation strikingly; this can produce a condition with low bone turnover, termed adynamic bone disease. For these reasons, serum levels of calcium and phosphorus, and those of intact PTH, must be monitored during vitamin D therapy, and vitamin D therapy adjusted accordingly (Algorithm 3, Algorithm 4, and Algorithm 5).
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  3. #3
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    Thank you. That is what I was looking for.
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  4. #4
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    Well, actually that is only part of the answer.

    It seems that the only time anyone worries about vitamin D levels is to control PTH, Ca, or P. There seems to be a new study every week proclaiming the benefits of UV exposure and increased vitamin D levels. Since someone with ESRD can't process these "previtamins" into an active form, should we be working a 4th value (vitamin D) into the 3 prong equation even when PTH, Ca and P are WNL?
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  5. #5
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    By the way, thanks again for the link.
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  6. #6
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    Default

    I was on Calcitriol for a long time due to always increasing PTH. My calcium and phosphorus were hard to control in spite of eating no calcium and taking tons and tons of binders.

    I was recently switched, after months and months of hassle, to hectorol. The first month after taking it, my PTH dropped significantly and even using fewer binders my phosphorus was in the low 4's.

    I honestly believe that the calcitriol was a big factor in my calcium being high as well as my phosphorus.

    Cathy
    home hemo 9/04

  7. #7
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    What is the difference between Calcitriol and Hectorol? Has anyone studied the info at the Scantibodies site?

  8. #8
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    Quote Originally Posted by billable View Post
    Well, actually that is only part of the answer.

    It seems that the only time anyone worries about vitamin D levels is to control PTH, Ca, or P. There seems to be a new study every week proclaiming the benefits of UV exposure and increased vitamin D levels. Since someone with ESRD can't process these "previtamins" into an active form, should we be working a 4th value (vitamin D) into the 3 prong equation even when PTH, Ca and P are WNL?
    I'm not a renal dietitian or a nephrologist and would recommend that you ask one of these professionals about this research. However, I have heard that fat soluble vitamins, like Vitamin A, D, E, and K, are more dangerous than water soluble ones because they can build up in the body faster in people whose kidneys don't work right. Also, drugs are expensive, can interact with food or other drugs, and can have serious side effects.

    Here's info from MedlinePlus on Vitamin D and other related compounds. It warns that Vitamin D can build up in the body to toxic levels.
    http://www.nlm.nih.gov/medlineplus/d...di/202597.html

    Here's the FDA approved labeling for Hectorol (doxercalciferol) that states that this drug should not be given unless the calcium x phosphorus product is <55 mg2/dl2.
    http://www.fda.gov/cder/foi/label/20...ctorol_lbl.pdf

    Here's information from the National Institutes of Health on Vitamin D. In skimming this article, it states that 10-15 minutes of sun exposure without sunscreen 2x/week is sufficient to give someone the Vitamin D that he/she needs. I would suggest asking the nephrologist (or dermatologist) if this is true for people with kidney disease.
    http://ods.od.nih.gov/factsheets/vitamind.asp

    Finally, there are many abstracts on PubMed that discuss the use of Vitamin D analogs in patients on dialysis and those with chronic kidney disease whose kidneys have not failed. Some studies look at morbidity and mortality with different drugs in dialysis patients. You might want to check them out.
    http://www.pubmed.gov
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  9. #9
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    Quote Originally Posted by Unregistered View Post
    What is the difference between Calcitriol and Hectorol? Has anyone studied the info at the Scantibodies site?
    Calcijex (calcitriol), Hectorol (doxercalciferol), Zemplar (paracalcitol) are different Vitamin D analogs.

    Quote Originally Posted by Unregistered View Post
    Has anyone studied the info at the Scantibodies site?
    Are you referring to this page on the Scantibodies website that links to professional and patient information?
    http://www.scltesting.com
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  10. #10
    Unregistered Guest

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    Quote Originally Posted by Beth Witten MSW ACSW View Post
    Calcijex (calcitriol), Hectorol (doxercalciferol), Zemplar (paracalcitol) are different Vitamin D analogs.

    Are you referring to this page on the Scantibodies website that links to professional and patient information?
    http://www.scltesting.com
    Cathy was saying Calcitriol and Hectorol affected her differently. So, I am asking how are they different?

    I haven't read the Scantibodies site yet. You have the correct site. Yes, the patient and professional info as well any other info on the site. I am planning on reading this info as it is the method my neph uses to deal with pth issues. He feels it is more accurate. Wondered if anyone else is aware of this site and has an opinion on what is presented there?

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