Comparison Effect of Loading Calcitriol and Titrating Calcitriol Treatment to Control Hypocalcemia after Parathyroidectomy in Chronic Kidney Disease: Randomized Control Trial, Open Labeled
Sathit Niramitmahapanya MD*, Chadsuphar Sirirachta MD*, Benjawan L. Niramitmahapanya MD**, Chaicharn Deerochanawong MD*, Udom Krairitichai MD**, Pornake Athipan MD***
Affiliation : * Endocrinology Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine Rangsit University, Bangkok, Thailand ** Nephrology Unit, Department of Internal Medicine, Rajavithi Hospital, College of Medicine Rangsit University, Bangkok, Thailand *** Department of Otolaryngology-head and neck, Rajavithi Hospital, College of Medicine Rangsit University, Bangkok, Thailand
Background : Postoperative parathyroidectomy hypocalcemia probably results from acute reversal of the parathyroid
hormone induced contribution of bone to maintain serum calcium concentration.
Objective : Compare the effective treatment of calcitriol regimens (loaded and titrated) in control hypocalcemic hyperparathyroid
(HPT) patients who were referred for parathyroidectomy.
Material and Method: A randomized control, open labeled study of 25 patients who underwent parathyroidectomy in
Rajavithi Hospital from August 2009 to September 2010 was conducted. The authors randomized 25 patients with chronic
kidney disease in two treatment arms of calcitriol (A: Titrated dose regimen, B: Loaded dose regimen), that met criteria.
Biochemical factors available within 2 weeks before and after surgery were recorded and analyzed.
Result: No significant difference was observed in amount of calcium gluconate intravenous use, hypocalcemia and hospital
admission durations between titrated and loaded regimen groups, i.e., p = 0.160, 0.645 and 0.460, respectively. Loaded
regimen ameliorated the mean reduction of day 7 postoperative mean change of serum calcium level by 0.33+0.99 mg/dl and
median change by 2.88 mg/dl (min, max = -0.80, 5.64) compared with titrate regimen mean change of serum calcium level by
2.68+2.16 mg/dl; median change 0.28 mg/dl (min, max = -0.84, 1.80) with significance, p = 0.036.
Conclusion : Loaded calcitriol regimen was superior to titrated calcitriol regimen compared with the control group the first
7 days postparathyroidectomy. Amount of calcium gluconate intravenous used, hypocalcemia and duration of hospital stay
did not show any significance.
Keywords : Parathyroidectomy, Hyperparathyroidism, Hypocalcemia, Calcitriol
