Prevention of renal osteodystrophy in predialysis patients

impaired calcitriol synthesis is one of the major factors contributing to t he development; of secondary hyperparathyroidism. in patients with chronic renal failure. Vitamin D therapy, particularly 1 alpha-hydroxyvitamin D-3, even in low doses, has been shown to be effective in the treatment of secon dary hyperparathyroidism in patients with mild-to-moderate chronic renal fa ilure. Complications associated with, calcitriol and alfacalcidol therapy, which include hypercalcemia and progressive deterioration of renal function , have been reported in some patients. The majority of the studies reviewed , however, demonstrated that daily calcitriol and alfacalcidol doses below 0.25 mu g are rarely associated with hypercalcemia, hyperphosphatemia, or p rogressive decline in renal function. In addition, these complications usua lly resolve with the reduction in dose or discontinuation of the medication . Thus, vitamin D therapy may be valuable in the treatment of patients with mild-to-moderate chronic renal failure who may be at high risk of developi ng secondary hyperparathyroidism.