Dose-response study of 22-oxacalcitriol in patients with secondary hyperparathyroidism

The dose-response relationships and the safety of administering 22-oxacalcitriol (OCT) to patients with secondary hyperparathyroidism (2HPT) under regular three-times-weekly hemodialysis (HD) were evaluated by double-blind parallel group design. A total of 203 patients with 2HPT were randomly allocated into four groups, and 5 microg (Group L), 10 microg (Group M), or 15 microg (Group H) OCT, or placebo (Group P) was administrated at the end of every HD for 12 weeks. Reductions of intact-parathyroid hormone (iPTH) concentration greater than 30% from baseline were observed in 7.7% of Group P as compared to 77.3% of the pooled OCT groups after 12 weeks of treatment (Mantel test: P < 0.001). Time-trends (slopes) of log-iPTH concentration calculated by least-squares line fitting to each patient's data during treatment differed between Group P and the pooled OCT groups (t-test: P < 0.001) and these iPTH slopes decreased dose-dependently (linear trend by t-test: P < 0.001). Slopes of serum calcium corrected for albumin (corrected-sCa) concentrations also differed between Group P and the pooled OCT groups (t-test: P < 0.001), and increased dose-dependently (linear trend by t-test: P < 0.0001). Serum phosphorus and Ca x P product increased significantly only in high dose groups. Slopes of log(iPTH) and corrected-sCa concentrations were reciprocally related. Most adverse events were hypercalcemia and dose-related, but occasionally comprised pruritus or increased serum creatinine phosphokinase. These results indicate that OCT produced a strong and dose-dependent suppression of PTH and an increase of corrected-sCa concentration in patients with 2HPT. The recommended initial dosages of OCT would appear to be 5 microg when pretreatment iPTH concentrations are less than 500 pg/mL, and 10 microg when greater than 500 pg/mL for safe and effective treatment. As in the case of PTH, calcium and phosphorus showed dose-dependent increases. It is therefore essential to take precautions as to possible increases in calcium and phosphorus.     

Effects of 22-oxacalcitriol and calcitriol on PTH secretion and bone mineral metabolism in a crossover trial in hemodialysis patients with secondary hyperparathyroidism

The purpose of this crossover comparison study is to elucidate the differences between the effects of a novel calcitriol analog, 22-oxacalcitriol, and calcitriol on parathyroid hormone (PTH) and bone mineral metabolism in hemodialysis patients with secondary hyperparathyroidism (SHPT). Twenty-three patients with moderate to severe SHPT were included in a random 2 x 2 crossover trial with two vitamin D analogs (12 weeks for each treatment). Two patients withdrew during the run-in period for personal reasons. Serum electrolyte, bone metabolic marker, intact PTH (iPTH) and whole PTH (wPTH) levels were measured periodically. The primary endpoint measure was a decrease in serum iPTH level, and the secondary outcome measures included changes in serum calcium (Ca), phosphate (P), and metabolic bone marker levels. Both treatments decreased iPTH and wPTH levels by similar degrees. Serum Ca, P, and Ca x P product levels at the end of each treatment were comparable and the frequencies of hypercalcemia and hyperphosphatemia were also similar during each treatment period. 22-Oxacalcitriol significantly decreased the levels of bone metabolic markers, namely, bone-specific alkaline phosphate, intact osteocalcin, pyridinoline, and cross-linked N-telopeptide of type I collagen, after a 12-week treatment. In contrast, calcitriol did not change any of the levels of bone metabolic markers. The present study showed that 22-oxacalcitriol is equally effective for PTH suppression, and Ca and P metabolism. In addition, 22-oxacalcitriol might have putative actions on bone remodeling independent of its PTH suppression. Further study is necessary to confirm the effects of 22-oxacalcitriol on bone metabolism in SHPT.     

Vitamin-D-resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism

We describe a sporadic, vitamin-D-resistant osteomalacic syndrome in 19 patients undergoing hemodialysis. The syndrome was found in less than 1.5% of patients from referring dialysis centers. All 19 patients had multiple fractures, severe myopathy, and many developed spontaneous hypercalcemia. Severe osteomalacia without evidence of secondary hyperparathyroidism distinguished this syndrome from other forms of renal osteodystrophy. Bone aluminum, measured in six patients, was greatly elevated. Therapy with calcitriol (1 alpha, 25-dihydroxycholecalciferol) lad to clinical improvement in seven patients with reduced pain and myopathy, decreased serum alkaline phosphatase, or both, but no improvement in bone histology. Patients who did not respond clinically to calcitriol developed marked hypercalcemia. The cause of this severe osteomalacia, which occurs despite normal or slightly elevated levels of serum calcium and phosphorus and fails to mineralize with calcitriol, is unclear.     

Cinacalcet hydrochloride therapy for secondary hyperparathyroidism in hemodialysis patients

This study compared the efficacy of a cinacalcet‐based regimen with unrestricted conventional therapy (vitamin D and phosphate binders) for achieving Kidney Disease Outcome Quality Initiative (K/DOQI) targets for dialysis patients. In this multicenter, prospective study, hemodialysis patients with poorly controlled secondary hyperparathyroidism (SHPT) were randomized to receive a cinacalcet‐based regimen (n = 55) or a conventional therapy (n = 27). Doses of cinacalcet, vitamin D sterols, and phosphate binders were adjusted during a 12‐week dose‐titration phase to achieve intact parathyroid hormone (iPTH) levels ≤ 31.8 pmol/L. The primary end point was the percentage of patients with values in this range during a 24‐week efficacy‐assessment phase. The clinical response to 36‐week cinacalcet treatment was evaluated. A dual energy X‐ray absorptiometry was performed before and after 36 weeks of cinacalcet therapy. Fifty‐eight percent of the cinacalcet group reached the primary end point, as compared with 19% of the conventional therapy group (P = 0.001). A higher percentage of patients receiving the cinacalcet‐based regimen versus conventional therapy achieved the targets for calcium, phosphorus and Ca × P. Achievement of targets was greatest in patients with less severe disease (intact PTH range, 31.8 to 53 pmol/L). Cinacalcet therapy increased proximal femur bone mineral density (BMD), but did not affect the lumbar spine. Itching intensity decreased significantly. Cinacalcet based treatment facilitates achievement of the K/DOQI targets for iPTH and bone mineral metabolism compared with conventional therapy in hemodialysis patients. Suppression of iPTH with cinacalcet reverses bone loss in the proximal femur. Cinacalcet alleviated itching.     

Long-term clinical effect of maxacalcitol on hemodialysis patients with secondary hyperparathyroidism

A trial on the long-term administration of 22-oxacalcitriol (maxacalcitol, OCT) was conducted among 124 patients with chronic renal failure on maintenance hemodialysis (HD) complicated with secondary hyperparathyroidism (2 degrees HPT ). In the trial, OCT was administered 3 times weekly for 26 weeks subsequent to a 26-week pre-trial. As a result, intact-parathyroid hormone (PTH) levels fell significantly after the start of administration and were well controlled for one year. The levels of markers of bone metabolism such as bone alkaline phosphatase were decreased significantly compared with those at the start of administration, suggesting a correction of high-turnover bone disease. Serum calcium (Ca) levels rose significantly following OCT administration, but were successfully maintained within a physiological range. Hypercalcemia, in 33.1% of patients, was found to resolve or ameliorate immediately after the withdrawal or dose reduction of OCT. The final doses ranged from 2.5 mg to 20 mg/HD, and the optimal dose varied among patients depending on the intact-PTH and serum Ca levels. These results clearly suggest that OCT is a highly effective drug for the treatment of 2 degrees HPT, and is an overall safe drug if the dosage is adjusted for serum Ca and intact-PTH levels.     

Effects of hemodialysis on secondary hyperparathyroidism in patients with chronic renal failure

In the first few weeks after the initiation of maintenance hemodialysis in nine patients with chronic renal failure, there was a progressive rise in both total and ionized serum calcium associated with a reciprocal and significant fall in the concentration of plasma parathyroid hormone. Studies in 36 additional patients with chronic renal failure already on hemodialysis indicated that this favorable trend did not continue; a progressive rise in parathyroid hormone concentration was associated with increasing duration of hemodialysis against the calcium concentration generally used by most centers. These observations are consistent with the increase in bone disease often associated with hemodialysis. Experimental increases in dialysate calcium concentration from 2.6 to 3.5 meq/liter for a 2-mo period failed to decrease parathyroid hormone secretion or cause a significant increase in predialysis calcium concentration in 36 uremic patients. Use of high calcium dialysis earlier in the course of the disease, alternate means of parathyroid suppression, and even subtotal parathyroidectomy may be necessary for the management of hyperparathyroidism in uremic patients undergoing hemodialysis.     

不同血液净化方法对肾衰合并继发性甲状旁腺功能亢进患者血清甲状旁腺激素水平的影响

目的探讨不同血液净化方法对慢性肾衰竭（CRF）合并继发性甲状旁腺功能亢进（SHPT）患者血清甲状旁腺激素水平的影响。方法将53例CRF合并SHPT患者随机分为血液透析（HD）组16例,血液透析滤过（HDF）组22例,血液灌流＋血液透析（HP＋HD）组15例,比较治疗前及治疗后6个月血清甲状旁腺激素（PTH）和钙、磷水平的变化。结果治疗后6个月与治疗前比较,HDF组、HP＋HD组PTH水平明显下降（P均〈0.01）,HP＋HD组血磷水平明显下降（P〈0.05）;三组治疗后血钙水平无明显变化。结论HP＋HD与HDF均能够使CRF合并SHPT患者PTH水平下降。     

阿法骨化醇冲击治疗对继发性甲状旁腺功能亢进症患者生活质量的影响

目的评价阿法骨化醇(1α-OHD3)冲击治疗对伴有继发性甲状旁腺功能亢进症(SHPT)且维持性血液透析患者生活质量的影响。方法选取2010年1月至2011年12月在河南科技大学第一附属医院血液净化科行维持性血液透析、SHPT者31例[血清全段甲状旁腺素(iPTH)>600pg/mL者17例;iPTH>300pg/mL者14例],分别应用阿法骨化醇7.5μg/周,分3次口服冲击治疗或阿法骨化醇0.5μg/d口服常规治疗。iPTH<600pg/mL时改为阿法骨化醇0.5μg/d口服常规治疗。收集治疗前后4、8、12、16、20和24周的数据,包括血磷、血钙、血碱性磷酸酶(ALP)血红蛋白(HB)、血清白蛋白(ALB)和iPTH。用肾脏疾病生活质量量表(KDQOL-SF)进行生活质量评分,分析各指标得分并进行比较。结果 2组患者治疗前血肌酐、尿素氮、血钙、血磷、ALP、血红蛋白、血清白蛋白等差异无统计学意义(均P>0.05);冲击治疗组在治疗24周后,血磷、ALP、iPTH与治疗前相比均明显下降(P<0.01);血钙与治疗前相比有所升高,但差异无统计学意义(P>0.05);血红蛋白、血清白蛋白治疗后有所升高,差异有统计学意义(P<0.05);常规治疗组iPTH与治疗前相比有所下降,但差异无统计学意义(P>0.05);治疗24周后,冲击治疗组与常规治疗组相比,血红蛋白、血清白蛋白差异有统计学意义;冲击治疗组治疗前KDQOL-SF评分与常规治疗组相比,生理功能、躯体疼痛、活力等3个指标降低(P<0.05);治疗24周后冲击治疗组的生理功能、躯体疼痛、活力、精神健康、情感职能5个指标明显提高(P<0.01);治疗24周后常规治疗组的生理功能、躯体疼痛、精神健康3个指标提高(P<0.05);治疗24周后,冲击治疗组与常规治疗组相比,精神健康、情感职能提高(P<0.05),其他指标差异无统计学意义。结论阿法骨化醇冲击治疗不仅可以有效治疗SHPT,还可以明显提高患者的生活质量。     

Seasonal profile of calcium-phosphate metabolism in hemodialysis patients with secondary hyperparathyroidism

Sunlight UV plays an important role in synthesis of active vitamin D3. Vitamin D3 concentration depends on seasonal sunlight exposure. It was not state, whether these changes may act on secondary hyperparathyroidism (SHP) in hemodialysis (HD) patients. The aim of our analysis was to assess the relationship between seasons and parameters of Ca-P metabolism in HD patients with SHP. We studied 30 pts (F = 17, M = 13), aged 20-72 years (mean 49 +/- 13), duration of HD therapy 3-132 months (mean 54.4 +/- 43.7), treated with alphacalcidol (1 alpha OHD3) due to SHP. Blood was collected for PTH, Ca, P concentrations in January (1), April (IV), July (VII) and October (X); also doses of CaCO3 and 1 alpha OHD3 were analyzed. The day duration was: 7 hours and 51 minutes (I), 12.53 (IV), 16.37 (VII) and 11.39 (X), respectively. PTH concentration was significantly higher in I vs IV (882 +/- 588 vs 691 +/- 511 pg/ml, p < 0.05) and higher in X vs VII (831 +/- 600 vs 701 +/- 525 pg/ml, p < 0.05), despite drug dosage did not differ. Calcium concentration was lower in I vs IV and X, and phosphate concentration was lower in I compared to IV, VII i X. These changes suggest presence of seasonal rhythm of PTH concentration in HD patients with SHP. When assessing the effectiveness of SHP therapy, the season of the year when PTH concentration was tested should be taken into account.     

Prevention and reversal of progressive secondary hyperparathyroidism in patients maintained by hemodialysis

In a group of patients maintained by hemodialysis, serum calcium and phosphorus values were not restored completely to normal, but there was a progressive decrease in serum parathyroid hormone (PTH) concentration and prevention or reversal of roentgenographic evidence of subperiosteal bone resorption. Although bone biopsies did not show a return of bone to normal, it was clear that the decrease in bone resorption was a direct function of decreased secretion of PTH. None of the patients required parathyroidectomy; in three of the nine patients who died the parathyroids were normal at autopsy. Although some patients showed minor evidence of metastatic calcification, only two showed a slight increase in vascular calcification, and none of the autopsies revealed calcification of vital organs.     

Dose determination of cinacalcet hydrochloride in Japanese hemodialysis patients with secondary hyperparathyroidism

Cinacalcet hydrochloride is a calcimimetic agent that activates the calcium-sensing receptor on the surface of parathyroid cells and inhibits parathyroid hormone (PTH) secretion. To manage secondary hyperparathyroidism, cinacalcet, which lowers PTH levels without increasing serum calcium, phosphorus and calcium-phosphorus product (Ca x P) levels, may provide a new potential therapy. To identify the optimal starting dose of cinacalcet for Japanese hemodialysis patients with secondary hyperparathyroidism, this double-blind, placebo-controlled, parallel, dose-finding study was conducted. One hundred and twenty Japanese hemodialysis patients with intact PTH levels greater than or equal to 300 pg/mL were randomized into four groups: placebo, and 12.5, 25 and 50 mg of cinacalcet. The treatment period was three weeks followed by a two-week follow-up observation period. Cinacalcet decreased serum intact PTH levels in a dose-dependent manner, and also decreased serum calcium, phosphorus, Ca x P, tartrate-resistant acid phosphatase and osteocalcin levels. The treatment with cinacalcet was generally well tolerated in this study. However, the incidence of treatment-related adverse events, such as gastrointestinal disorders and hypocalcemia, and the rate of withdrawal from the study due to treatment-related adverse events were higher in the 50 mg dose group than in the other groups. On the basis of both efficacy and safety results, 25 mg has been identified as the optimal starting dose of cinacalcet for Japanese hemodialysis patients with secondary hyperparathyroidism.     

Effect of salmon calcitonin on bone mineral density and calcium-phosphate metabolism in chronic hemodialysis patients with secondary hyperparathyroidism

The aim of the study was to evaluate the effect of salmon calcitonin on bone mineral density, parathyroid and thyroid C cells, and calcium-phosphate metabolism in chronic hemodialysis patients with uremic hyperparathyroidism. Forty five patients with serum 1-84 PTH >220 pg/ml were divided into 2 groups: group I (n = 25), treated with intranasal salmon calcitonin (200 IU, thrice a week) and control group II (n = 20). Patients received calcium carbonate (up to 6 g/d) alone or with aluminum hydroxide (up to 3 g/d) as phosphate binders; dialysate calcium was 1.75-2 mmol/l. The observation period was 12 months. The following parameters were measured: bone mineral density (BMD) with dual-energy X-ray absorptiometry in: lumbar spine (L2-L4), femoral neck and total body, before and after the study; serum endogenous calcitonin, before and after the study; serum PTH, alkaline phosphatase and total hydroxyproline, before and after 1, 3, 6, and 12 months; and serum calcium and phosphate monthly. During 12 months of the study, a substantial reduction in BMD was observed in all examined regions in group II (-2.8 +/- 2.1%; p<0.01 in L2-L4, -2.4 +/- 2.0%; p<0.01 in femoral neck, and -1.9 +/- 1.4%; p<0.01 in total body), whereas in group I a slight increase of bone mineral was noted, however insignificant. The inhibition of bone resorption was accompanied by a marked decrease in serum hydroxyproline. No changes in parathyroid activity were noted nor any decrease in serum phosphate. The treatment had no influence on serum endogenous calcitonin; initial concentrations were elevated in 47% of patients. CONCLUSION: Intranasal salmon calcitonin: 1) has no influence on bone mineralization in dialysis patients with uremic hyperparathyroidism; 2) has no significant effect on serum phosphate concentration; 3) provided adequate calcium supplementation doesn't stimulate parathyroid glands; 4) has no influence on endogenous calcitonin secretion.     

Control of secondary hyperparathyroidism during long-term hemodialysis

The hyperparathyroidism which occurs during long-term hemodialysis of patients with chronic renal failure has been successfully controlled without the need for subtotal parathyroidectomy. Utilizing a highly sensitive radioimmunoassay for plasma parathyroid hormone (iPTH), it was found that iPTH was correlated negatively with dialysate calcium concentration and positively with plasma phosphate concentration. Manipulation of these factors separately demonstrated that iPTH could be significantly decreased in two to three weeks by simultaneously decreasing plasma phosphate and increasing dialysate calcium. On the basis of calcium flux studies across the dialyzer, it was determined that the optimal calcium concentration in the dialysate was 8 mg/100 ml. Ten patients were treated by initially decreasing their plasma phosphate to less than 6 mg/100 ml (by giving them oral aluminum hydroxide) and using dialysis against a calcium concentration of 8 mg/100 ml. All patients have manifested a substantial and progressive decrease in plasma iPTH toward normal, with alleviation of bone pain and absence of complications, during use of this regimen.     

A long-term comparative study of calcitriol versus alphacalcidol in patients with secondary hyperparathyroidism on hemodialysis

Calcitriol has traditionally been the most widely used treatment for secondary hyperparathyroidism (SHPT) in uremic patients. There are currently no crossover equivalence studies of alphacalcidol versus calcitriol establishing which of the two derivatives is more active and better tolerated. The objective of this study was to compare the long term effect on control of PTH of similar doses of alphacalcidol versus calcitriol in the treatment of SHPT in these patients. METHODS: We conducted a retrospective study on 21 hemodialysis patients with stable SHPT of varying severity treated with intravenous calcitriol. In July 2002, the pharmacy of the reference hospital decided to substitute calcitriol for alphacalcidol based on the similarity of the two drugs. The conversion was made substituting a similar amount of drug. Mean absolute serum levels and percentage change in PTH, calcium and phosphorus were compared between the two periods and at 0, 3, 6, 9, 12 and 15 months after starting treatment with alphacalcidol. Student's t-test for paired means was used to compare the values between the two periods. RESULTS: In the calcitriol period, mean PTH levels were 275.2 +/- 111.7 pg/ml. The mean dose of drug used was 1.7 +/- 0.8 mcg postdialysis, and serum calcium and phosphorus levels were 10.1 +/- 0,5 mg/dl and 5,2 +/- 0,9 mg/dl, respectively (p < 0.01). Mean dialysate calcium content was 2,9 +/- 0,3 mEq/l. In the alphacalcidol period, PTH increased (441.6 +/- 178.3 pg/ml) (p < 0.001) and the percentage of patients with PTH < 300 pg/ml decreased (24% at the end of the period), in spite of significantly increasing the mean drug dose (2,3 +/- 0,9 mcg postdialysis) (p < 0.05). Serum calcium levels did not show significant differences (10.2 +/- 0.7 mg/dl) (p = NS), but phosphorus control was improved (4,7 +/- 0,5 mg/dl) (p < 0.01). The percentage of patients with PTH < 300 pg/ml decreased progressively from the start of treatment with alphacalcidol from 75% to 24% at the end of follow-up. Our results seem to suggest that the dose of alphacalcidol and calcitriol are not equivalent and we need to increase the dose of alphacalcidol to obtain a similar result to calcitriol on suppression of PTH in uremic patients with SPTH.     

血液透析血液灌流对继发甲状旁腺功能亢进的影响

目的观察血液灌流比较血液透析滤过对慢性肾衰竭维持血液透析患者继发性甲状旁腺功能亢进的影响。方法选取2004年8月至2005年11月河北大学第二医院维持性血液透析患者40例,分为2组,比较单次血液透析串联血液灌流(HD HP)治疗,及单次血液透析滤过(HDF)治疗前后,患者血甲状旁腺激素(PTH)和磷(P)的清除力和清除百分比。结果单次血液透析串联血液灌流后,慢性肾衰竭维持血液透析患者血PTH下降明显,血钙(Ca)增高。结论血液透析串联血液灌流后患者骨病的临床症状好转;血液灌流可以明显降低患者的PTH,能很好地改善维持性血液透析患者的继发性甲状旁腺功能亢进症状。     

血液透析血液灌流对继发甲状旁腺功能亢进的影响

目的观察血液灌流比较血液透析滤过对慢性肾衰竭维持血液透析患者继发性甲状旁腺功能亢进的影响。方法选取2004年8月至2005年11月河北大学第二医院维持性血液透析患者40例，分为2组，比较单次血液透析串联血液灌流（HD＋HP）治疗，及单次血液透析滤过（HDF）治疗前后，患者血甲状旁腺激素（PTH）和磷（P）的清除力和清除百分比。结果单次血液透析串联血液灌流后，慢性肾衰竭维持血液透析患者血PTH下降明显，血钙（Ca）增高。结论血液透析串联血液灌流后患者骨病的临床症状好转；血液灌流可以明显降低患者的PTH，能很好地改善维持性血液透析患者的继发性甲状旁腺功能亢进症状。     

Vitamin D receptor activator reduces oxidative stress in hemodialysis patients with secondary hyperparathyroidism

Treatment with a vitamin D receptor activator (VDRA) has survival benefits probably related to its effects beyond the traditional role in mineral metabolism. We hypothesized that VDRA reduces oxidative stress in hemodialysis (HD) patients. To test this hypothesis, we investigated the effect of VDRA on the oxidative status of albumin in HD patients with secondary hyperparathyroidism. Eleven HD patients with secondary hyperparathyroidism were treated with calcitriol at an intravenous dose of 1.5 μg/week for four weeks. Serum intact parathyroid hormone, calcium and phosphorus were monitored and we measured the amount of oxidized albumin and albumin hydroperoxides form before and after calcitriol treatment. The ratio of oxidized to un-oxidized albumin was determined as a representative marker of oxidative stress. The radical scavenging activity of albumin was also evaluated. After four weeks of calcitriol therapy, there were no significant changes in serum intact parathyroid hormone, calcium, or phosphorus levels; however, the ratio of oxidized to un-oxidized albumin was markedly decreased and serum thiol content was significantly increased after calcitriol treatment. Furthermore, the radical scavenging activity of albumin was greater after calcitriol treatment compared with that of untreated albumin. Our data suggest that intravenous calcitriol treatment reduces oxidative stress and strengthens antioxidant defenses by inhibiting albumin oxidation in HD patients with secondary hyperparathyroidism.     

Effect of calcium supplementation on blood pressure in patients with secondary hyperparathyroidism

The aim was to study the effect of calcium supplementation 477 mg twice daily on BP in patients with secondary hyperparathyroidism during an intervention study (6 weeks) and after 954 mg during a short study (3 h). The intervention study was a placebo-controlled, double-blind, cross-over, while the short study gave a placebo and calcium in random order on separate days. The participants were obtained from an epidemiological survey in Troms? 1994-1995 that included more than 27.000 subjects. The re-examination was performed in 2000/2001 at the University Hospital of North Norway, Norway. There were 18 subjects with secondary hyperparathyroidism and 28 control subjects in the intervention study while there were 14 cases and 8 control subjects in the short study. The results showed that in the subjects with secondary hyperparathyroidism after calcium supplementation in the intervention study there was an increase in serum calcium from 2.28 +/- 0.09 to 2.36 +/- 0.06 mmol/l (mean +/- SD) and a decrease in serum PTH from 8.6+/-1.6 to 6.5+/-2.4 pmol/l. However, there was no significant difference in either systolic or diastolic BP between calcium supplementation and placebo (138.3 +/- 21.0 vs 135.9 +/- 17.0 mm Hg and 80.9 +/- 11.1 vs 78.9+/-9.5 mm Hg, respectively). Similar results were seen in the control group. In the short study, serum calcium increased and serum PTH decreased after oral calcium, but the BP did not differ as compared to when placebo was given. To conclude, in the present setting we did not find any effect on BP by calcium supplementation in subjects with moderate secondary hyperparathyroidism.