Kidney Week

Abstract: TH-PO138

Alfacalcidol vs. Calcitriol in the Management of Secondary Hyperparathyroidism in CKD

Session Information

• CKD-MBD: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Ghosn, Muriel, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Muriel Ghosn, MD, FASN

• El Nekidy, Wasim, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Wasim El Nekidy

• Mallat, Jihad, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Jihad Mallat, MD, MSc, PhD

• Hijazi, Fadi A., Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Fadi A. Hijazi, MD, FASN

• Madhyastha, Rakesh, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Rakesh Madhyastha, MD, FASN

• Abidi, Emna, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Emna Abidi, MSc, PhD

• Ghazal, Iyad, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Iyad Ghazal, MSc

• Malik, Amir Riaz, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Amir Riaz Malik, MBBS

Background

This study aims to assess the efficacy of alfacalcidol compared to calcitriol in reducing iPTH levels in patients with chronic kidney disease

Methods

This retrospective cohort study was conducted at our quaternary care hospital between January 1^st, 2022, and December 31^st, 2022. Adult Patients diagnosed with CKD stage 3 to 5 (not on dialysis) who received alfacalcidol for at least 3 months followed by calcitriol for another 3 months were included. Laboratory values were assessed at baseline, at 3 months while on alfacalcidol then at 3 months while on calcitriol. The primary outcome was the suppression of the iPTH , while the secondary outcome was the effect on total serum calcium. The study was approved by the hospital’s research ethics committee

Results

Seventy adult patients were included in the analysis. Statistical analysis was conducted using Wilcoxon signed rank test and McNemer test. CKD stage 3 comprised 47.1% of the sample while stage 4 comprised 37.1%. The median dose of alfacalcidol was 0.5 (0.25-0.8) mcg, compared to 0.5 (0.25-0.5) mcg for calcitriol (p= 0.001). The median time between baseline and outcome laboratory measurements was 94 (83-106) days for alfacalcidol and 94 (78.5-110.5) for calcitriol (p= 0.676). No significant differences were observed in the use of phosphate binders or non-active vitamin D between the time periods. Alfacalcidol did not significantly suppress the iPTH levels with median values of 13.31 (8.23 - 24.4) pg/mL at baseline and 12.5 (8.86 - 24.7) pg/mL after 3 months (p= 0.937). In contrast, calcitriol significantly reduced the iPTH levels from 12.5 (8.86 - 24.7) pg/mL to 10.7 (5.7 -19) pg/mL (p= 0.017). Additionally, alfacalcidol did not significantly increase calcium levels, with values of 2.29 (2.2 - 2.3) mmol/L at baseline and 2.3 (2.23 - 2.36) mmol/L after 3 months (p=0.237), whereas calcitriol significantly increased calcium levels from 2.3 (2.23 - 2.36) mmol/L to 2.34 (2.27 - 2.43) mmol/L (p=0.001). Albumin values remained unchanged throughout the study period

Conclusion

Calcitriol, at significantly lower doses, was more effective than alfacalcidol in reducing iPTH levels and increasing calcium levels over 3 months. Larger prospective controlled studies are needed to confirm these findings