Abstract
Hitherto, serum Ca level in chronic hemodialysis patients was controlled with only the Ca concentration of the dialysate. But its high Ca dialysate could not inhibit the progress of renal osteodystrophy, because of the remarkable intradialytic change of serum Ca. Therefore, we tried to decrease the intradialytic change of serum Ca by the oral administration of 1α-OH-D3. Then we also intend to improve renal osteodystrophy in combination with low Ca dialysate.
1α-OH-D3 was administerd to 53 chronic dialysis patients. Dialysate Ca level was sequentially exchanged every 3 months, from 3.5mEq/l to 3.0mEq/l and from 3.0mEq/l to 2.5mEq/l. Serum Ca level was controlled by the dose of 1α-OH-D3 to maintain above 8.0mg/dl. Concentrations of serum Ca, P, Mg and AL-P were measured, twice a month, and serum PTH-C were measured at every 3 months.
By the oral administration of 1α-OH-D3, pre-HD serum Ca level rose from 8.0mg/dl to 8.9mg/dl. Intradialytic Ca change, that is interdialytic Ca change, decreased from 2.0mg/dl to 0.6mg/dl. Daily total dose of 1α-OH-D3 to all patients were increased gradually from 7.75μg/day to 36.5μg/day.
Concentration of serum P, Mg and AL-P had no significant change, but serum PTH-C level rose from 2.1ng/ml to 3.7ng/ml. In combination with low Ca dialysate, oral administration of 1α-OH-D3 could decrease both intradialytic and interdialytic changes of serum Ca level. The improvement of renal osteodystrophy will be expected by this combination therapy.
