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Abstract: PO2300

Incidence of Hypercalcemia with Calcitriol Compared with Paricalcitol in Pediatric Patients Receiving Hemodialysis

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Dwivedi, Rohan, Texas Children's Hospital, Houston, Texas, United States
  • Morris, Jennifer L., Texas Children's Hospital, Houston, Texas, United States
  • Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
  • Swartz, Sarah J., Texas Children's Hospital, Houston, Texas, United States
Background

At our institution, both calcitriol and paricalcitol are available for use. Paricalcitol is generally used when adverse effects of calcitriol are observed or during times of calcitriol shortage. There are limited data on the efficacy and safety of vitamin D analogs in pediatric (ped) hemodialysis (HD) patients (pts) to support preference of either agent. This study evaluated the incidence of hypercalcemia in ped HD pts receiving calcitriol compared to paricalcitol.

Methods

Single-center, retrospective review of ped pts on HD treated between January 2012 – December 2018 who received in-center doses of calcitriol or paricalcitol. Pts were excluded if they received in-center doses of both paricalcitol and calcitriol or if they had incomplete data. Pts were not excluded from either group if they had an active prescription for oral calcitriol for home. Data were collected for 6-months from the date of the first in-center calcitriol or paricalcitol dose. The primary objective was to evaluate the incidence of hypercalcemia in those receiving calcitriol compared to paricalcitol. Secondary objectives included the incidence of hyperphosphatemia, high calcium-phosphorus product, and hyperparathyroidism (iPTH). Data were evaluated using descriptive statistics, Mann-Whitney-U and Fisher’s Exact test.

Results

34 pts met the criteria for the study (calcitriol group = 15; paricalcitol group = 19). The groups had no statistically significant differences at baseline. Patients in the paricalcitol group received an average weekly dose of 14 ± 7 mcg, equivalent to 4.67 ± 2.33 mcg of calcitriol compared to 2.36 ± 1.51 mcg in the calcitriol group (p=0.002). There were no differences between the time averaged serum calcium, phosphorous, calcium-phosphorus product, and iPTH between the two groups. Between the paricalcitol and calcitriol groups the incidence of hypercalcemia events per patient (EPP), based on age-related normal calcium was 1.11 and 0.53 (p=0.23), hyperphosphatemia EPP was 3.74 and 2.67 (p=0.20) and high iPTH EPP was 2.63 and 2.2 (p=0.38).

Conclusion

The incidence of hypercalcemia in patients receiving paricalcitol compared to calcitriol was high but did not reach statistical significance. There is no clear advantage seen with the use of paricalcitol when compared to the calcitriol group in peds population.