Acute Effect of Pamidronate on PTH Secretion in Postmenopausal Hemodialysis Patients with Secondary Hyperparathyroidism

Kuo Cheng Lu, Lai King Yeung, Shih Hua Lin, Yuh Feng Lin, Pauling Chu

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: The purpose of this study is to evaluate the acute effect of pamidronate on plasma ionized calcium (iCa) level reduction and dynamic parathyroid hormone (PTH) secretion in postmenopausal hemodialysis-dependent women with secondary hyperparathyroidism. Methods: Twelve postmenopausal women undergoing regular hemodialysis with serum intact PTH levels greater than 200 pg/mL (200 ng/L) were included in this study. Pamidronate was administered intravenously as a single dose of 15 mg in the last hour of hemodialysis. PTH responses to hypocalcemia and hypercalcemia induced with 1 mEq/L (0.5 mmol/L) and 4 mEq/L (2 mmol/L) of dialysate calcium, respectively, were evaluated before and 1 week after pamidronate therapy. Results: Pamidronate therapy resulted in a decrease in predialysis basal plasma iCa (iCabase; P <0.05) levels and an increase in maximal serum PTH (PTHmax; P <0.001), basal PTH (PTHbase; P <0.001), and minimal PTH levels (P <0.001). The set point of serum calcium and the slope of the PTH-calcium curve were not altered by pamidronate therapy. An inverse correlation was present between iCabase and the PTHbase-PTHmax ratio before (r = -0.66; P <0.05) and after (r = -0.84; P <0.001) pamidronate therapy. Conclusion: Our study shows that pamidronate therapy is associated with reduced plasma iCa levels and increased PTH secretion, resulting in aggravated secondary hyperparathyroidism. These findings suggest that secondary hyperparathyroidism may worsen after the administration of pamidronate, at least in the short term, in postmenopausal hemodialysis patients.

Original languageEnglish
Pages (from-to)1221-1227
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume42
Issue number6
DOIs
Publication statusPublished - Dec 2003
Externally publishedYes

Keywords

  • Bisphosphonate
  • Calcium set point
  • Hemodialysis (HD)
  • Pamidronate
  • Postmenopausal
  • Secondary hyperparathyroidism
  • Uremia

ASJC Scopus subject areas

  • Nephrology

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