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Aims: Secondary hyperparathyroidism is an early complication of chronic kidney disease (CKD), with increasing severity as the glomerular filtration rate decreases. Treatment with calcitriol can occasionally result in hypercalcemia and hyperphosphatemia in renal patients, but next generation vitamin-D analogs such as paricalcitol have lower intestinal absorption of calcium and phosphorous. Our aim was to assess whether paricalcitol is more beneficial than calcitriol in pre-dialysis CKD patients in clinical practice., Method: This observational study was carried out in a clinical setting. A total of 220 patients diagnosed with CKD stages 2 - 4, who had been previously treated with calcitriol (0.25 μg/48 hours) for 6 months, were screened. 45 patients presenting total calcium > 9.5 mg/dL or serum phosphate > 4.5 mg/dL and who did not meet exclusion criteria werefinally selected, and their calcitriol treatment was switched to paricalcitol. Baseline blood and urine analyses were performed before switching treatment, and then repeated after 6-month treatment with paricalcitol (1 μg/45 h). Baseline and follow-up data were compared., Results: No significant changes were detected in the total serum calcium, ionized calcium, serum phosphate, tubular reabsorption of phosphate, urinary phosphate, or parathyroid hormone. There was a slight decrease in plasma calcitriol levels after switching to paricalcitol. Only urinary calcium levels showed a significant decrease: 58.1 ± 7.4 mg/24 hours during calcitriol treatment and 48.9 ± 6.1 mg/24 hours after 6 months with paricalcitol (p = 0.04)., Conclusion: Compared to calcitriol, paricalcitol decreases urinary calcium excretion in pre-dialysis CKD patients, suggesting that paricalcitol treatment for secondary hyperparathyroidism might result in less systemic calcium overload.

The aim of this study was to find out the relationship between body iron stores and serum aluminum levels among 82 stable CAPD patients. The influence of other factors such as time on CAPD and residual renal function was also considered. Thirty-three patients received aluminum hydroxide as a phosphate binder, and they had significantly higher aluminum levels (36.45 microg/l) than the patients who were not taking aluminum preparations (17.2 microg/l, p = 0.001). A statistically-significant correlation between serum aluminum levels and residual renal function and time on CAPD was also observed (p <0.05). However, there was no relationship between serum aluminum levels and serum iron, ferritin and transferrin saturation, neither between body iron stores and total excretion of aluminum (p >0.05). In previous reports, low serum iron levels were associated with high serum aluminum concentration among hemodialysis patients. However, this effect was not observed in the CAPD population under study. The highest risk of hyperaluminemia was found in the patients who were taking aluminum hydroxide, had worse residual renal function and had been longer on CAPD.

The i-PTH response to changes in the peritoneal calcium balance was studied prospectively in a group of 13 stable CAPD patients, who presumably had adynamic bone disease, with low or normal i-PTH values and low aluminum in plasma. Five days after the reduction of dialysate calcium concentration from 1.75 mmol/l to 1 mmol/l, there was a significant elevation in the serum i-PTH. These increased PTH levels returned to baseline values when patients were changed to the 1.75 mmol/l Ca solution (p = 0.004). The changes in i-PTH mirrored the changes in peritoneal calcium balances. These results support the notion that the low or normal levels of i-PTH frequently seen in peritoneal dialysis patients are due to the hypercalcemic effects of the standard peritoneal dialysis solutions; in these patients, the parathyroid hormone production is normal since negative peritoneal balances of calcium are associated with an increase in serum i-PTH.

Candida peritonitis was treated with fluconazole in ten continuous ambulatory peritoneal dialysis (CAPD) patients without immediate removal of the peritoneal catheter. Shortly prior to diagnosis, six patients (60%) had received broad-spectrum antibiotics. Gram stain of peritoneal fluid detected yeast in 70% of cases. In eight patients the peritoneal dialysis catheter was removed within one week of diagnosis because of clinical deterioration. In the majority of cases (90%), candida peritonitis resolved only after catheter removal in spite of ongoing fluconazole therapy. Fluconazole was well tolerated by all patients.