HIGH-DOSE ALFACALCIDOL IMPROVES ANEMIA IN PATIENTS ON HEMODIALYSIS

Background. Alfacalcidol is efficient for treating secondary hyperpara thyroidism in patients on maintenance haemodialysis (HD). Little is kn own about the direct impact of high-dose alfacalcidol on anaemia in en d-stage renal failure. We therefore carried out a prospective study ov er 18 months to examine the direct effect of high-dose alfacalcidol on erythropoiesis in erythropoietin (rHuEpo)-dependent anaemic patients on HD for more than 6 months with moderate hyperparathyroidism. Study design. Twelve patients received oral alfacalcidol at a dosage of 6-7 mu g per week and calcium carbonate during the first 12 months, calciu m carbonate without alfacalcidol during the next 3 months, and again a lfacalcidol and calcium carbonate during the last 3 months. Criteria f or selection were haemoglobin <10 g/dl, iPTH >250 pg/ml, transferrin s aturation (TS) >25%, S-ferritin >300 mu g/l, and S-aluminium <40 mu g/ l. Results. Haemoglobin (Hb) and reticulocyte counts increased during the first phase, decreased and returned to a baseline prior to startin g vitamin D treatment in the second phase, and again increased when al faclcidol was reintroduced, whereas iPTH decreased during the first 3 months of the first phase and then remained stable, as did S-calcium, which increased during the first 3 months and then remained constant. S-phosphate increased during the first and third phases, and decreased during the second phase. Two patients during the first phase and one patient during the third phase presented hypercalcaemia; requiring a t emporary discontinuation of alfacalcidol. Conclusion. High-dose alfaca lcidol is efficient in anaemic patients with moderate hyperparathyroid ism on maintenance HD and has a direct effect on erythropoietic cells regardless of serum calcium and iPTH levels.