The usefulness of intravenous maxacalcitol therapy for secondary hyperparathyroidism after percutaneous ethanol injection therapy (PEIT)

Secondary hyperparathyroidism (II° HPT) is a major complication in chronic hemodialysis patients, and percutaneous ethanol injection therapy (PEIT) has recently become a useful alternative treatment for II° HPT. Although Fukagawa et al. established guidelines for selective PEIT to treat secondary hyperparathyroidism, the protocol for treatment after PEIT has not yet been fully discussed. Recently, maxacalcitol has been developed and effects on II° HPT are expected, but there are few reports on its usefulness as a treatment after PEIT. To evaluate the effectiveness of intravenous maxacalcitol therapy for treatment after selective PEIT, we examined intact-PTH, bone metabolism marker, parathyroid gland volume and bone mineral density before, six months and 12 months after PEIT. The study population consisted of 5 hemodialysis patients with high intact-PTH (>400pg/mL) and one or two swelling parathyroid glands using power Doppler ultrasonography. Intravenous maxacalcitol therapy was started one week after PEIT. Informed consent for PEIT was accepted for all patients. Consequently, successful controls of intact-PTH, serum Alp, intact-osteocalcin and parathyroid gland volume were eventually achieved by intravenous maxacalcitol therapy after selective PEIT. Bone mineral density did not show significant change after PEIT. There were no side effects from intravenous maxacalcitol therapy, such as high calcium, during the 12 months after PEIT. In conclusion, it was suggested that intravenous maxacalcitol therapy would be very useful in treating secondary hyperparathyroidism after PEIT.