Intermittent or daily administration of 1-alpha calcidol for nephrectomised infants on peritoneal dialysis?

Secondary hyperparathyroidism and renal osteodystrophy are major problems in patients with end-stage renal failure and may result in poor growth in children on dialysis. Whether vitamin D sterols should be given intermittently or daily remains a controversial issue. We studied 16 bilaterally nephrectomised infants with congenital nephrosis of the Finnish type (median age 0.54 years), all on peritoneal dialysis. Nine of them were receiving intermittent 1-α calcidol therapy and seven daily 1-α calcidol therapy. The target serum parathyroid hormone (PTH) level was 2–3 times the upper limit of normal (ULN). There were no statistically significant differences in PTH values between the groups (1.7-times vs 0.5-times the ULN at 3 months and 3.1-times vs 3.4-times the ULN at 6 months, respectively). The required weekly doses of 1-α calcidol were low, and there were no significant differences between the intermittent and daily groups (0.06 μg/kg vs 0.04 μg/kg at 3 months and 0.09 μg/kg vs 0.05 μg/kg at 6 months, respectively). The infants on intermittent 1-α calcidol showed significant catch-up growth during dialysis after nephrectomy relative to the infants on daily 1-α calcidol (−1.6 SD to −0.7 SD vs −1.4 SD to −1.0 SD, respectively; P < 0.05). Our results indicate that either intermittent or daily vitamin D analogue therapy, if started early, will prevent secondary hyperparathyroidism equally well in children on peritoneal dialysis (PD), but intermittent therapy might be more favourable for growth.