Intravenous Calcitriol Lowers Serum Calcium Concentrations in Uraemic Patients with Severe Hyperparathyroidism and Hypercalcaemia

: We studied the effects of intravenous calcitriol in four persistently hypercalcaemic patients established on haemodialysis. All had marked hyperparathyroidism and had been previously shown to be intolerant to vitamin D by mouth. Calcitriol was administered at the end of each dialysis session in doses of 0.5-2.5 micrograms for 2 months and continued for 7 and 8 months in two patients. A significant decrease in serum calcium was observed after 2 weeks, which was maintained throughout treatment despite increasing the dose of calcitriol. This was associated with a decrease in serum concentrations of iPTH (28% of the initial value at 4 weeks), suggesting a shift in the set-point for PTH secretion. During longer-term treatment, serum calcium values increased, but lower concentrations of iPTH were maintained. We conclude that an increment in serum calcium is not a prerequisite for the suppressive action of calcitriol on parathyroid secretion and that the presence of hypercalcaemia does not preclude its use. Longer-term studies on a larger number of patients are required to assess the therapeutic potential of intravenous calcitriol in hypercalcaemic patients.