Ask Your Question - Renal Failure

1. When can we give One-Alpha® injection in case of renal failure with hyperparathyroidism?
One rationale for the intravenous with One-Alpha® in the treatment of secondary hyperparathyroidism, is to escape intestinal degradation of the hormone and thereby achieve a high concentration of the Vitamin D compound in the parathyroid glands to cause a direct inhibition of PTH synthesis and release through action on the specific Vitamin D receptors located on the parathyroid tissue.

 
2. My patient is on renal dialysis around 10 years. His last PTH is 2500 which caused a brown tumor at the lower jaw. He is taking One-Alpha® for more that a year (3mcg/twice weekly) and there is no response. Please advice.
If the patient is taking oral form of One-Alpha®:

 
 


 
QUESTION
1. When can we give One-Alpha® injection in case of renal failure with hyperparathyroidism? 
 
ANSWER
One rationale for the intravenous with One-Alpha® in the treatment of secondary hyperparathyroidism, is to escape intestinal degradation of the hormone and thereby achieve a high concentration of the Vitamin D compound in the parathyroid glands to cause a direct inhibition of PTH synthesis and release through action on the specific Vitamin D receptors located on the parathyroid tissue.

Intravenous One-Alpha® is recommended in the following:
 

  • When PTH levels are >500 pg/ml
  • When effective and rapid suppresion of PTH is required
  • When PTH is not satisfactory controlled with evident hyperphoshataemia/hypercalcaemia
  • To delay or prevent the need for parathyroidectomy
  • To improve compliance and adherence to One-Alpha® therapy



 
QUESTION
2. My patient is on renal dialysis around 10 years. His last PTH is 2500 which caused a brown tumor at the lower jaw. He is taking One-Alpha® for more that a year (3mcg/twice weekly) and there is no response. Please advice. 
 
ANSWER
If the patient is taking oral form of One-Alpha®:

 

  • Shift the patient to intravenous One-Alpha®
    • Initial does of One-Alpha® IV = current weekly dose of oral One-Alpha®
  • Measure PTH 10-15 days and adjust the IV One-Alpha® dose accordingly
    • Up to 16 mcg of intravenous One-Alpha® can be given weekly