Oral vs intravenous (IV) pulsed alfacalcidol for the treatment of secondary hyperparathyroidism (SHPT) in haemodialysis patients; an audit of efficacy and cost
by Jim Moriarty
Poster Download
Introduction
Activated Vitamin D remains the mainstay of treatment for secondary hyperparathyroidism (SHPT) in haemodialysis patients. There is variable evidence as to whether oral or intravenous administration of the Activated Vitamin D preparation alfacalcidol is superior.
Aim
Our audit aimed to show comparable efficacy of pulsed oral vs IV alfacalcidol in the control of SHPT for haemodialysis patients, by measuring monthly bone profile and three-monthly parathyroid hormone (PTH).
Methods
A supply shortage of IV alfacalcidol led to 11 patients being switched to oral alfacalcidol in the second week of Oct. 2018 at the same dose as previous IV therapy. Bone profile including calcium and phosphate were measured monthly before the switch, and monthly for 6 months after. PTH was measured at baseline, 3 and 6 months.
Results
After 6 months, the PTH (51 to 58 pmol/l) calcium (2.45 to 2.38 mmol/L), and phosphate (1.81 to 1.90 mmol/L) were not significantly altered. Alfacalcidol doses did not increase over the audit period (1.40 mcg/dose to 1.34 mcg/dose)
Costs for IV alfacalcidol in our unit are £0.259/mcg and oral alfacalcidol £0.158/mcg. Paricalcitol (an alternative IV activated vitamin D preparation) costs £12.50 per equivalent dose. Including savings from nursing time and use of consumables, we estimate approximately £4000 savings compared to IV alfacalcidol, and £20000 competed to IV paricalcitol, in a single small satellite unit
Conclusion
Our findings support the safety and efficacy of oral rather than IV pulsed alfacalcidol for haemodialysis patients with SHPT, with substantial cost benefits.