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the first in the musculoskeletal system and the second in the cardiovascular system&#46; The first is due to increased bone remodelling&#44; whose usual injury is fibrous osteitis&#44; with a loss of bone mass and structural integrity of the bones&#46;<span class="elsevierStyleSup">9&#44;10</span> These renal osteodystrophy lesions have been documented via bone biopsies in very early stages of CKD&#46;<span class="elsevierStyleSup">11&#44;12</span> The second is associated with an increased risk of cardiovascular calcification&#44; with vascular toxicity playing an important part&#46;<span class="elsevierStyleSup">9&#44;10&#44;13&#44;14</span></p><p class="elsevierStylePara">The usual treatment for SHPT includes restriction of dietary phosphorus&#44; phosphorus binders and administration of vitamin D receptor activators&#46; More recently&#44; calcimimetic cinacalcet has been added to the therapeutic arsenal&#46; This activates the calcium receptor and inhibits PTH secretion&#44; in addition to having other effects&#46;</p><p class="elsevierStylePara">Calcitriol is the most frequently used vitamin D analogue&#46; However&#44; available data shows it to have the significant disadvantage of increasing the absorption of calcium and phosphorus&#44; with the consequent risk of hypercalcaemia&#46; This may lead to increased vascular calcification and an increased cardiovascular mortality risk in certain circumstances&#46;<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara">Therefore&#44; new drugs to activate the vitamin D receptor have been developed with less effect on the intestinal absorption of calcium and phosphorus&#46; Paricalcitol is a third-generation drug that selectively activates the vitamin D receptor &#40;VDR&#41;&#44; depending on the tissue&#46;<span class="elsevierStyleSup">16</span></p><p class="elsevierStylePara">It has been shown experimentally to suppress PTH secretion&#44; but with minimal changes in calcaemia and phosphoraemia&#46;<span class="elsevierStyleSup">17-19</span> Moreover&#44; there is evidence in animal models showing that treatment with paricalcitol does not increase the expression of procalcifying markers in vascular smooth muscle cells&#46; This does not happen with vitamin D analogues&#44; which do overexpress some of these markers&#44; increasing vascular calcification&#46; This vascular calcification protective effect&#44; typical of paricalcitol&#44; is independent of serum calcium&#44; phosphorus or PTH&#46;<span class="elsevierStyleSup">20&#44;21</span></p><p class="elsevierStylePara">Several clinical trials and post-authorisation studies have shown that paricalcitol is able to control the effects of SHPT with less hypercalcaemia and hyperphosphataemia than calcitriol in haemodialysis patients&#46;<span class="elsevierStyleSup">14-26</span> One well-known study observed an increase in survival after a 2-year follow-up for haemodialysis patients who switched to paricalcitol from calcitriol&#46;<span class="elsevierStyleSup">23</span></p><p class="elsevierStylePara">Another reason for this study was the current lack of clinical experience of non-dialysis patients with early hyperparathyroidism treated with paricalcitol&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient selection</span></p><p class="elsevierStylePara">Those included were stable patients over 18 years of age&#44; without concomitant severe disease&#44; with an established grade 3 or 4 diagnosis of CKD&#46; They were referred for the first time to the Nephrology Department of the San Cecilio Clinical Hospital&#44; Granada from primary care or another consultation in our hospital between October 2008 and June 2010&#46;</p><p class="elsevierStylePara">The inclusion criteria were to present SHPT with intact parathyroid hormone &#40;iPTH&#41; values &#62;70 pg&#47;ml for patients with CKD grade 3 and iPTH &#62;110 pg&#47;ml in patients with CKD grade 4&#46; Patients were excluded if they had total serum calcium&#62;9&#46;5 mg&#47;dl or had received treatment with vitamin D&#44; vitamin D analogues&#44; phosphate binders&#44; calcium salts&#44; drugs that might alter calcium or bone metabolism such as bisphosphonates and&#47;or calcitonin in the previous 6 months&#46; Patients with significant comorbidity or an inability to continue treatment were also excluded&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives and endpoints</span></p><p class="elsevierStylePara">The objective was to establish the effectiveness and safety of oral paricalcitol administration in patients with CKD grades 3 and 4 &#40;estimated MDRD GFR of 59-30ml&#47;min&#47;1&#46;73m&#178; and 29-15ml&#47;min&#47;1&#46;73m&#178;&#44; respectively&#41; under the usual clinical practice conditions at our hospital&#46; We retrospectively analysed our clinical experience by considering the main analysis variable as the effectiveness of oral paricalcitol&#44; as described previously&#44; in achieving 2 consecutive reductions of 30&#37; or more from baseline iPTH&#46;</p><p class="elsevierStylePara">The secondary effectiveness variable analysed was the percentage of patients who fulfilled the Spanish Society of Nephrology &#40;SEN&#41; and the Kidney Foundation Disease Outcomes Quality Initiative &#40;K&#47;DOQI&#41; guidelines&#46; These included iPTH &#60;70pg&#47;ml &#40;CRD 3&#41; and iPTH &#60;110pg&#47;ml &#40;CRD 4&#41;&#44; with calcium in the range 8&#46;4-9&#46;5mg&#47;dl and phosphorus in the range 2&#46;7-4&#46;6mg&#47;dl&#46;</p><p class="elsevierStylePara">In addition&#44; the relationship between treatment success and different patient variables were analysed&#46;</p><p class="elsevierStylePara">The primary safety variable in the study was the follow-up of total calcium values to detect the presence of hypercalcaemia with a total calcium &#62;10&#46;5mg&#47;dl&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Follow-up and medication procedures</span></p><p class="elsevierStylePara">The treatment follow-up was retrospective analysis at 6 months by comparing data from the baseline visit &#40;V1&#41; with two successive visits with a 3-month interval&#44; V2 &#40;second visit&#41; and V3 &#40;third visit&#41;&#46; The diagnosis&#44; prescription and follow-up were carried out by a single doctor&#46;</p><p class="elsevierStylePara">The initial dose of paricalcitol was determined according to the baseline concentrations of iPTH described in another study&#46;<span class="elsevierStyleSup">22</span> A daily dosing regimen was chosen&#44; with an initial dose of 1&#181;g per day when the iPTH was &#8804;500pg&#47;ml&#44; and 2&#181;g per day when &#8805;500pg&#47;ml&#46;<span class="elsevierStyleSup">22</span></p><p class="elsevierStylePara">At the following quarterly visits&#44; the dose was modified according to the iPTH response following the usual method in our clinic&#46; If the reduction of iPTH was &#60;15&#37;&#44; the dose was doubled&#59; if the reduction was between 30&#37; and 60&#37;&#44; it was maintained&#59; and if the reduction was &#62;60&#37;&#44; it was halved&#46; If serum calcium was &#62;10&#46;2mg&#47;dl&#44; the dose was reduced&#44; and if it was &#62;10&#46;5mg&#47;dl&#44; the medication was temporarily suspended&#46; Fortnightly determinations of calcium were then performed and the therapy restarted after normalisation of serum calcium&#46;</p><p class="elsevierStylePara">Patient clinical data from the central computerised and centralised hospital medical records was taken and analysed statistically&#46; They included the age&#44; sex&#44; body mass index &#40;BMI&#41;&#44; CKD etiology&#44; concomitant treatments&#44; serum calcium level&#44; serum phosphorus&#44; total cholesterol&#44; HDL cholesterol&#44; LDL cholesterol&#44; triglycerides&#44; haemoglobin&#44; calculated creatinine clearance&#44; Cockroft-Gault GFR&#44; estimated MDRD GFR and calcidiol levels &#40;25-OH vitamin D&#41;&#46; Patients were asked beforehand for permission to use these data for the computer analysis via a data confidentiality agreement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Laboratory methods</span></p><p class="elsevierStylePara">Total calcium and phosphorus serum levels&#44; as well as the other analytical parameters&#44; were measured with an autoanalyser according to hospital laboratory procedures&#46; The calcium values in this study were expressed as uncorrected total calcium levels with serum protein or albumin levels&#46; PTH was determined by electrochemiluminescence &#40;EQL Elecsys PTH&#44; Roche&#41;&#44; and the results corrected with the coefficient 0&#46;97 to express them as IRMA NICHOLS according to the K&#47;DOQI guidelines&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">A descriptive analysis of the categorical variables was conducted by calculating the frequency of each&#46; For quantitative variables&#44; the mean and standard deviation were calculated when the distribution was normal&#59; and the median and interquartile range when the distribution was not normal&#46; Some quantitative variables were categorised&#46;</p><p class="elsevierStylePara">Statistical significance was assessed using the chi-square test &#40;for categorical variables&#41;&#44; Student&#39;s t test or the nonparametric Wilcoxon test as appropriate &#40;for quantitative variables&#41;&#46; The univariate association analysis was performed using the chi-square test&#44; Student&#39;s t-test or the Mann-Whitney U test&#46;</p><p class="elsevierStylePara">The relationship between treatment success and different variables was analysed in a univariate or multivariate logistic regression&#46; The goodness of fit was assessed by the Hosmer and Lemeshow test&#46;<span class="elsevierStyleSup">24</span></p><p class="elsevierStylePara">Calcium and phosphorus levels were measured to evaluate the safety of the treatment by analysing the appearance of hypercalcaemia or hyperphosphataemia&#46; Calcaemia was categorised into four levels as follows&#58; &#8804;8&#46;5mg&#47;dl&#44; &#62;8&#46;5 and &#8804;9&#46;5mg&#47;dl&#44; &#62;9&#46;5 and &#8804;10&#46;5mg&#47;dl and &#62;10&#46;5mg&#47;dl&#46; The distribution of patients in each category was studied&#46; Also&#44; the presentation of moderate hypercalcaemia was analysed &#40;percentage of patients with a value &#62;10&#46;2mg&#47;dL in at least one visit&#41;&#44; which resulted in the dose having to be reduced&#44; and significant hypercalcaemia &#40;percentage of patients with a value &#62;10&#46;5mg&#47;dl&#41; that forced the temporary suspension of treatment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Demographic and baseline parameters</span></p><p class="elsevierStylePara">Initially&#44; 99 patients who met the inclusion criteria were selected&#44; 7 of whom had incomplete data at 6 months &#40;1 for voluntarily discontinuing treatment and 6 because the follow-up was lost before the 3rd visit&#41;&#46; Therefore&#44; the final analysis was of 92 patients who had completed 6 months treatment&#46;</p><p class="elsevierStylePara">The mean age was 73&#177;11 years&#44; and 50&#37; were women&#46; There was a higher frequency of moderate CKD &#40;55&#46;4&#37; with CKD 3&#41; than serious CKD &#40;44&#46;5&#37; with CKD 4&#41;&#46; The most frequent etiology of CKD was diabetes &#40;33&#46;7&#37;&#41;&#44; followed by vascular &#40;27&#46;6&#37;&#41;&#44; interstitial &#40;5&#46;1&#37;&#41; and polycystic kidney disease &#40;3&#46;1&#37;&#41;&#46; There were 28&#46;6&#37; of cases with unknown etiology&#46; The mean body mass index &#40;BMI&#41; was 30&#46;6&#177;6&#44; indicating an overweight population&#46; The mean total cholesterol was 182&#46;3&#177;44mg&#47;dl&#44; HDL cholesterol was 51&#46;3&#177;15mg&#47;dl and LDL cholesterol was 103&#46;2&#177;33mg&#47;dL&#44; which meant a relatively controlled lipid profile in most patients&#46; There were 35&#46;7&#37; of patients under treatment with angiotensin-converting enzyme &#40;ACE&#41; inhibitors and 42&#46;9&#37; with angiotensin II receptor antagonists &#40;ARBs&#41; for associated hypertension &#40;HT&#41;&#44; see Table 1&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Analysis of treatment effectiveness</span><span class="elsevierStyleBold"></span></p><p class="elsevierStylePara">The planned review sequence was quarterly&#44; with the average actual time being 11&#46;7&#177;3 weeks for the second visit &#40;V2&#41; and 25&#46;6&#177;6 weeks for the third &#40;V3&#41;&#46;</p><p class="elsevierStylePara">The mean paricalcitol doses administered at the 3 study times were as follows&#58; at the baseline visit&#44; patients were prescribed 7&#46;4&#177;2&#46;4mg&#47;week&#44; at the 2nd visit it was 6&#46;8&#177;2&#46;4mg&#47;week and in the 3rd visit it was 5&#46;2&#177;3&#46;2mg&#47;week&#46;</p><p class="elsevierStylePara">The primary outcome of the study was achieved in 54&#46;3&#37; of patients&#44; who had a reduction of &#8805;30&#37; in iPTH levels at the 2nd visit &#40;V2&#44; 3 months&#41; which was maintained at the 3rd visit &#40;V3&#44; 6 months&#41;&#46; In addition&#44; another 16&#46;3&#37; of patients achieved a decrease of &#8805;30&#37; in iPTH levels at the 3rd visit &#40;V3&#41;&#46; Thus&#44; 70&#46;6&#37; of all patients had decreased their iPTH by over 30&#37; at 6 months&#44; compared to baseline&#46;</p><p class="elsevierStylePara">As the iPTH values did not follow a normal distribution&#44; they were expressed as median and interquartile range &#40;Figure 1&#41;&#46; The median iPTH shows a statistically significant decrease of 33&#46;1&#37; between baseline &#40;V1&#41; and the 2nd visit &#40;V2&#41;&#44; from 163 to 109pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#46; There was also a statistically significant change between the 2nd &#40;V2&#41; and 3rd &#40;V3&#41; visits&#58; decreasing by 25&#46;2&#37; from 109 to 81&#46;5pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#46; Overall&#44; for all patients&#44; over 6 months of the study&#44; the median iPTH decreased significantly by 50&#46;0&#37;&#44; from 163 to 81&#46;5pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; see Table 2 and Figure 1&#46;</p><p class="elsevierStylePara">The reductions in iPTH allowed a proportionately lower dose of paricalcitol to be used&#44; from 7&#46;4&#177;2&#46;4 to 6&#46;8&#177;3&#46;08&#181;g&#47;week &#40;V2&#41; and 5&#46;2&#177;3&#46;2&#181;g&#47;week &#40;V3&#41;&#46;</p><p class="elsevierStylePara">As a secondary objective&#44; the treatment effectiveness was analysed according to the K&#47;DOQI guidelines&#44; which took into account the calcium and phosphorus values&#44; in addition to PTH&#46; The proportions of patients meeting these target levels at 6 months were&#58; iPTH 31&#46;6&#37;&#44; calcium 69&#46;6&#37; and phosphorus 58&#46;7&#37;&#44; although only 26&#46;1&#37; of patients achieved all these objectives simultaneously &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara">Variations in total serum calcium &#40;baseline 9&#46;0&#177;0&#46;5mg&#47;dl and end 9&#46;2&#177;0&#46;7mg&#47;dl&#41; were not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;12&#41;&#46; Similarly&#44; changes in serum phosphorus &#40;baseline 3&#46;5&#177;0&#46;6mg&#47;dl and final 3&#46;6&#177;0&#46;6mg&#47;dl&#41; were not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;2&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara">The different renal function calculations also showed no significant changes&#58; diuresis &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41;&#44; Cockroft-Gault GFR &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41; and MDRD GFR &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;7&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara">We also observed small variations in the levels of calcidiol&#44; which are likely to reflect the seasonal changes due to the different times of year analysed&#46; Their values increased slightly from 16&#46;2&#177;8ng&#47;ml to 18&#46;2&#177;10ng&#47;ml&#44; which was not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;13&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Relationship between treatment effectiveness and diabetes and chronic kidney disease grade</span></p><p class="elsevierStylePara">There were no significant differences in the primary endpoint for diabetic and non-diabetic patients&#44; with the objective being achieved in 56&#46;2&#37; of diabetics and 53&#46;3&#37; of non-diabetics&#46;</p><p class="elsevierStylePara">Significant differences were detected in the relationship between effectiveness and CKD grade&#44; as the primary endpoint was achieved in 67&#37; of patients with CKD 4 versus 44&#37; of those with CKD 3 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;05&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Other factors associated with effectiveness&#58; univariate and multivariate associations</span></p><p class="elsevierStylePara">The univariate logistic regression analysis found a significant positive association between the main efficacy variable &#40;probability of treatment success&#41; and increased renal affectation &#40;CKD 4 vs&#46; CKD 3&#41; &#91;odds ratio &#40;OR&#41; of 2&#46;52&#59; 95&#37; confidence interval &#40;CI&#41; of 1&#46;07-5&#46;97&#93; and higher baseline iPTH levels &#40;OR 1&#46;02&#59; 95&#37; CI&#58; 1&#46;01-1&#46;03&#41;&#46; While the probability of treatment success was lower for a higher BMI &#40;OR 0&#46;87&#59; 95&#37; CI&#58; 0&#46;79-0&#46;95&#41;&#44; higher creatinine clearance &#40;OR 0&#46;97&#59; 95&#37; CI 0&#46;93-0&#46;99&#41; and increased GFR estimate by Cockroft-Gault &#40;OR 0&#46;95&#59; 95&#37; CI&#58; 0&#46;91-0&#46;99&#41;&#46;</p><p class="elsevierStylePara">In the multivariate logistic regression analysis&#44; baseline iPTH was chosen as an explanatory variable&#44; as it was the most statistically significantly successful parameter for the goal of the study&#46; Also&#44; BMI was included in the multivariate model as an additional variable&#44; and the equation was adjusted for the variables of sex and age&#46; The resulting model showed a good fit&#46; The result was an increase of 2&#37; treatment success for each unit increase in baseline iPTH &#40;OR 1&#46;02&#59; 95&#37; CI&#58; 1&#46;01-1&#46;03&#41;&#44; and a decrease of 17&#37; for each unit increase in BMI &#40;OR 0&#46;83&#59; 95&#37; CI&#58; 0&#46;75-0&#46;93&#41;&#46; In both cases&#44; the results were independent of the age or sex of patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatment Safety</span></p><p class="elsevierStylePara">Most patients had serum calcium levels between 8&#46;5 and 9&#46;5mg&#47;dl during follow-up&#58; 72&#46;4&#37; at the 2nd visit &#40;V2&#41; and 69&#46;6&#37; at the 3rd visit &#40;V3&#41;&#46; Only 2 patients &#40;2&#46;1&#37;&#41; had calcium levels above 10&#46;5mg&#47;dl&#46; Moreover&#44; 5 patients &#40;5&#46;4&#37;&#41; were observed with calcium levels above 10&#46;2mg&#47;dl &#40;1 case at V2 and 4 cases at V3&#41;&#46;</p><p class="elsevierStylePara">Also&#44; calcium values below 8&#46;5mg&#47;dl were observed in 9&#46;2&#37; of patients at V2 and 8&#46;7&#37; of patients at V3&#46;</p><p class="elsevierStylePara">Variations in the mean calcium and phosphorus during the study were not statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Other adverse effects</span></p><p class="elsevierStylePara">Seemingly transient symptoms of nausea and&#47;or vomiting attributed to the drug were found in 3 patients &#40;3&#46;06&#37;&#41;&#44; who were receiving numerous medications&#46; However&#44; because of their transitory nature&#44; it was not necessary to discontinue the medication&#46;</p><p class="elsevierStylePara">One patient &#40;1&#46;02&#37;&#41;&#44; also being administered many drugs simultaneously&#44; dropped out of treatment at the 3rd visit voluntarily&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The data collected in this study from our consulting practice&#44; and those applied retrospectively to patients with similar criteria in the literature&#44; show a high effectiveness for paricalcitol in controlling SHPT in patients with CKD stages 3 and 4 when administered in a daily regimen&#44; with no significant changes in calcaemia or phosphoraemia&#46;</p><p class="elsevierStylePara">There was a significant decrease of 50&#46;0&#37; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; in median iPTH in our patients from baseline &#40;163pg&#47;ml&#41; to the end of the study &#40;81&#46;5 pg&#47;ml&#41;&#46; This significant reduction fulfilled the main objective of the study for 54&#46;3&#37; of patients who achieved &#8805;30&#37; reductions in iPTH levels at 3 months and maintained this decrease at 6 months&#59; ie&#44; they had 2 consecutive decreases compared to baseline&#46; Our results are smaller in magnitude than those in Coyne&#39;s study&#44; where 90&#37; of patients achieved a similar objective&#46;<span class="elsevierStyleSup">22</span> We believe these differences are due to the different study conditions&#46; Coyne&#39;s study was a controlled clinical trial with a prospectively determined primary objective&#44; while ours was limited by the conditions in a normal hospital clinic and the data were studied retrospectively&#46; Furthermore&#44; Coyne&#39;s study was based on PTH levels greater than ours&#44; therefore patients received mean doses of paricalcitol larger than ours&#46; Finally&#44; the time intervals and follow-up times were also different&#46;</p><p class="elsevierStylePara">Another aspect observed in our patients was that there was a greater reduction &#40;35&#46;5&#37; vs 24&#46;4&#37;&#41; in iPTH between baseline &#40;V1&#41; and the 2nd visit &#40;V2&#41; than between the 2nd &#40;V2&#41; and 3rd visits &#40;V3&#41;&#46; This is consistent with previous studies which have shown decreases in iPTH levels of 30&#37; in the first 2 months with progressively less decreases in the following months&#46;<span class="elsevierStyleSup">18&#44;22&#44;25</span> In total&#44; we observed a median decrease of 50&#46;0&#37; in iPTH from baseline levels until the end of study &#40;V1 to V3&#41;&#46; This meant that 70&#46;6&#37; of patients reduced their iPTH by more than 30&#37; over 6 months&#46;</p><p class="elsevierStylePara">This reduction compares favourably with similar studies&#46; In a long-term open multicentre study for oral paricalcitol&#44; a progressive decrease in iPTH was seen up to the 13th month of treatment&#46;<span class="elsevierStyleSup">25</span> In other studies&#44; the effects of paricalcitol were compared with calcitriol&#44; a non-selective vitamin D analogue&#44; and significantly larger and faster decreases in iPTH were observed with paricalcitol than with calcitriol&#46;<span class="elsevierStyleSup">26&#44;27</span> Another recent study conducted with 40&#46;5&#37; of patients receiving cinacalcet in haemodialysis associated with paricalcitol&#44; experienced a 50&#37; reduction in PTH&#44; which was comparable to our patients who only received paricalcitol&#46;<span class="elsevierStyleSup">28</span></p><p class="elsevierStylePara">Moreover&#44; the significant decreases in iPTH in our patients allowed the paricalcitol dose to be gradually reduced from a weekly average of 7&#46;4g at the start to an average of 5&#46;2&#181;g at the end&#44; with the maximum degree of iPTH control&#46; This is a 29&#46;7&#37; reduction in the dose over the 6 months of the study&#44; as found by other authors&#46; In an open&#44; long-term prospective study&#44; the paricalcitol dose was significantly reduced throughout the study while maintaining suppression of the iPTH&#46;<span class="elsevierStyleSup">26</span></p><p class="elsevierStylePara">Another way to analyse the treatment effects on mineral metabolism disorders is to evaluate compliance with values considered optimal by different clinical practice guidelines&#44; such as the K&#47;DOQI guidelines proposed by the American National Kidney Foundation<span class="elsevierStyleSup">29</span> and the SEN guidelines&#46;<span class="elsevierStyleSup">30</span> According to both guidelines&#44; 31&#46;6&#37; of our patients were within the range for iPTH&#44; 66&#46;9&#37; were within the range for calcaemia and 58&#46;7&#37; were within the range for phosphoraemia at the end of the study period&#46; Also&#44; 26&#46;1&#37; of patients managed all 3 parameter targets simultaneously&#46; It should be noted that the iPTH level treatment algorithm for our patients was not designed prospectively to achieve the margins proposed by these guidelines&#46;</p><p class="elsevierStylePara">The difficulty in complying with the K&#47;DOQI criteria has long been known&#44; and has been described as a &#8220;painful&#8221; or &#8220;uphill&#8221; battle&#46; They had scarcely been published&#44; when it was found that few patients were meeting them&#46; One of the first studies&#44; in haemodialysis patients&#44; found 20&#37; of patients complying with iPTH levels and only 8&#37; for all 3 parameters simultaneously&#46;<span class="elsevierStyleSup">31</span> In the Spanish SEN multicentre study&#44; OSERCE II&#44; which included patients with CKD not on dialysis in 39 centres&#44; it was found that 30&#37; were within the K&#47;DOQI range for PTH&#44; 35&#46;6&#37; for calcium and 76&#46;5&#37; for phosphorus&#46; This study highlighted the difficulty of reducing the PTH&#44; especially when compared with another similar study of 3 years earlier by the same authors&#44; which achieved a similar decrease in PTH&#46;<span class="elsevierStyleSup">32</span> Similarly&#44; another study in our group collected data from the Sistema de Informaci&#243;n de Coordinaci&#243;n Auton&#243;mica de Trasplante Andaluza &#40;Andalusian Transplant Autonomy Coordination Information System&#44; SICATA&#41; for the years 2007&#44; 2008 and 2009 concerning the control of PTH according to the K&#47;DOQI guidelines in haemodialysis patients&#46; The percentage within the range for iPTH was 32&#46;4&#37; &#40;in 2007 and 2008&#41; and 35&#37; &#40;in 2009&#41;&#46; It should also be noted that between 13&#46;5&#37; and 15&#37; of patients were within the range simultaneously for all 3 parameters&#58; calcium&#44; phosphorus and PTH&#46;<span class="elsevierStyleSup">33</span> Finally&#44; a multicentre Italian study &#40;Italian FARO Survey&#41;&#44; involving 2&#44;637 patients from 28 haemodialysis centres&#44; also showed the difficulty in complying with the K&#47;DOQI guidelines&#46; There were 26&#46;8&#37; of patients within the iPTH range at baseline and 32&#37; at 18 months&#46;<span class="elsevierStyleSup">34</span> Thus&#44; these studies illustrate the difficulty in achieving the guideline objectives for both dialysis and in CKD not on dialysis&#46;</p><p class="elsevierStylePara">Moreover&#44; as a secondary aim in our study&#44; we evaluated the various factors that could influence the response to treatment&#46; There was no difference between diabetic &#40;56&#46;2&#37; success&#41; and non-diabetic patients &#40;53&#46;3&#37; success&#41; regarding a decrease &#8805;30&#37; in iPTH levels</p><p class="elsevierStylePara">However&#44; the treatment was more effective in patients with CKD grade 4 than those with grade 3&#44; for both the primary endpoint and secondary measures &#40;reduction in iPTH in at least 1 visit&#41;&#46; In addition&#44; logistic regression results confirmed an association between treatment effectiveness and the CKD grade &#40;greater effectiveness in CKD grade 4&#44; lower creatinine clearance&#44; lower Cockroft estimate or lower MDRD&#41;&#46; One possible explanation is that it is more difficult to lower iPTH to a normal range the closer you are to it&#44; and easier the farther away&#44; at least in early hyperparathyroidism where there is only diffuse hyperplasia of the parathyroid glands and they are sufficiently sensitive to the activation of the vitamin D receptor &#40;VDR&#41;&#46;</p><p class="elsevierStylePara">The association with BMI showed that the higher this was&#44; the lower the likelihood of treatment success&#46; Other authors in a recent paper also noted that a higher BMI had a worse response to oral paricalcitol in renal failure before dialysis&#44; and that obesity is a factor in poor treatment response as was seen in our patients&#46;<span class="elsevierStyleSup">35</span></p><p class="elsevierStylePara">Analysis by a multivariate model showed similar results&#44; ie&#44; that the effectiveness of treatment increased with higher baseline iPTH level and decreased with increasing BMI&#46;</p><p class="elsevierStylePara">Finally&#44; the most common risks of treating patients with CKD grades 3 or 4 with vitamin D analogues are causing hypercalcaemia&#44; hyperphosphataemia and increased Ca x P product&#46; It is known that selective activation of VDRs&#44; as happens with paricalcitol&#44; lowers intestinal absorption of these ions&#44; significantly decreasing these risks&#44; as seen in the Coyne study&#46;<span class="elsevierStyleSup">22</span> It emerged from our study&#44; that treatment with paricalcitol&#44; in addition to its effectiveness&#44; leads to safe management of the drug&#44; as only 5 cases of moderate hypercalcaemia &#62;10&#46;2mg&#47;dl &#40;5&#46;4&#37; of patients&#41; were seen&#44; which represented 2&#46;6&#37; of all analytical results at the 6 months follow-up&#46; Moreover&#44; 2 cases &#40;2&#46;1&#37; of patients&#41; had severe hypercalcaemia &#62;10&#46;5mg&#47;dl which forced the temporary suspension of the drug&#46; As reported in other studies&#44;<span class="elsevierStyleSup">22</span> a slight average increase in calcium levels of 0&#46;1-0&#46;2mg&#47;dl was seen&#44; which is not statistically significant&#46; There were no significant changes in levels of phosphorus&#44; nor any determination with hyperphosphataemia&#46; Our data are comparable to those of other studies&#44; where the incidence of adverse effects&#44; hypercalcaemia&#44; hyperphosphataemia and high calcium-phosphorus product was similar in both the paricalcitol group and placebo group patients&#46;<span class="elsevierStyleSup">14&#44;22&#44;25&#44;26</span> Given the particular importance that selective activation of VDR is acquiring&#44; in both vascular calcification protection<span class="elsevierStyleSup">36</span> and its potential pleiotropic effects&#44;<span class="elsevierStyleSup">37&#44;38</span> we believe our experience with this drug could be particularly useful&#44; in terms of effectiveness and safety&#46;</p><p class="elsevierStylePara">Another problem that must be taken into account with treatments is the global tolerance to these substances&#46; In our study&#44; it was observed that paricalcitol was well tolerated&#46; Adverse effects&#44; which were mainly gastrointestinal&#44; were very few&#44; mild and were resolved in a few weeks without discontinuing the treatment&#46; Only 3 patients &#40;3&#46;06&#37;&#41; were affected&#59; while 1 patient &#40;1&#46;02&#37;&#41;&#44; taking plenty of other medications&#44; discontinued treatment by choice due to feeling generally unwell and nauseous without vomiting&#46; None of the analytical tests showed any abnormality to explain the symptoms the patient reported&#46; Similar data are found in other studies&#46;<span class="elsevierStyleSup">14&#44;22</span></p><p class="elsevierStylePara">In conclusion&#44; our data suggest that under the routine clinical practice conditions in our clinic&#44; oral paricalcitol can be used as a treatment of choice in early hyperparathyroidism for patients with CKD stages 3 and 4&#46; There is a sufficient degree of efficiency&#44; safety and tolerance&#44; and clinical results comparable to those of published controlled trials could be expected&#46;</p><p class="elsevierStylePara">The main effort in this study was to try to apply the skills of rigorous&#44; prospective studies with a control group to normal clinical practice&#46; Therefore&#44; the difficulty in validating our data&#44; due to few previous studies in clinical practice conditions similar to ours&#44; is recognized as a study limitation&#46; A second limitation is the small number of patients treated&#44; and a third is the lack of a longer-term follow-up&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;16025&#95;23734&#95;en&#95;t1&#95;11030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_16025_23734_en_t1_11030.jpg" alt="Demographic and baseline parameters"></img></a></p><p class="elsevierStylePara">Table 1&#46; Demographic and baseline parameters</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23735&#95;en&#95;t211030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23735_en_t211030.jpg" alt="Changes in key variables in the 3 visits"></img></a></p><p class="elsevierStylePara">Table 2&#46; Changes in key variables in the 3 visits</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23736&#95;en&#95;f111030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23736_en_f111030.jpg" alt="iPTH values &#40;expressed as median and interquartile range&#41;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; iPTH values &#40;expressed as median and interquartile range&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23737&#95;en&#95;f211030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23737_en_f211030.jpg" alt="Percentage of patients after 6 months treatment meeting the K&#47;DOQI guideline values for calcium&#44; phosphorus and iPTH"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Percentage of patients after 6 months treatment meeting the K&#47;DOQI guideline values for calcium&#44; phosphorus and iPTH</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n y objetivos&#58; </span>El hiperparatiroidismo secundario es una complicaci&#243;n habitual en pacientes con insuficiencia renal cr&#243;nica&#46; El tratamiento con paricalcitiol&#44; activador selectivo del receptor de vitamina D&#44; ha demostrado tener beneficios en el tratamiento de estos pacientes al disminuir adecuadamente la hormona paratiroidea &#40;PTH&#41; con m&#237;nimas variaciones del calcio y f&#243;sforo s&#233;ricos&#46;&#160;El objetivo de este estudio es evaluar la efectividad y la seguridad del paricalcitol en el tratamiento de pacientes con insuficiencia renal cr&#243;nica &#40;ERC 3 y 4&#41;&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Se llev&#243; a cabo un an&#225;lisis de datos de nuestra experiencia&#44; en condiciones de pr&#225;ctica cl&#237;nica habitual&#44; en 92 pacientes de m&#225;s de 18 a&#241;os con diagn&#243;stico de ERC de grado 3 y 4&#46; Los pacientes incluidos en el mismo fueron tratados con paricalcitol y evaluados mediante controles peri&#243;dicos cada tres meses&#46; Como medida principal de efectividad se estableci&#243; la obtenci&#243;n&#160;de dos disminuciones en visitas consecutivas &#8805;del 30&#37; de la hormona paratiroidea intacta &#40;PTHi&#41; respecto a las cifras basales&#46; Se analizaron como objetivos secundarios el cumplimiento de los objetivos de acuerdo con las gu&#237;as de la Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;S&#46;E&#46;N&#46;&#41;&#160;y Kidney Diseases Outcome Quality Initiatives&#160;&#40;K&#47;DOQI&#41;&#44; y&#44; tambi&#233;n&#44; la relaci&#243;n entre la efectividad del tratamiento y las diferentes variables registradas de los pacientes&#46;&#160;La variable principal de seguridad estudiada fue la aparici&#243;n de hipercalcemia&#46; <span class="elsevierStyleBold">Resultados&#58; </span>El objetivo principal del estudio lo cumplieron el 54&#44;3&#37; &#160;de los pacientes&#46; Adicionalmente&#44; en otro 16&#44;3&#37; de los pacientes disminuy&#243; la PTHi m&#225;s del 30&#37; al llegar a la tercera visita &#40;a los seis meses&#41;&#46; En conjunto&#44; un 70&#44;6&#37; de los pacientes hab&#237;an conseguido reducir m&#225;s del 30&#37; los niveles de PTHi&#160; a los seis meses con el tratamiento con paricalcitol&#46; La relaci&#243;n entre el &#233;xito del tratamiento y el grado de filtrado glomerular fue significativa&#44; as&#237; como su relaci&#243;n con el &#237;ndice de masa corporal&#46; Apenas hubo efectos adversos&#59; se hall&#243;&#160;hipercalcemia en un 2&#44;1&#37; de los pacientes&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>El tratamiento con paricalcitol presenta una buena efectividad en el control del hiperparatiroidismo secundario en pacientes no en di&#225;lisis&#44; bajo condiciones de pr&#225;ctica cl&#237;nica habitual con un alto grado de seguridad&#46;&#160;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Purpose&#58; </span>Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease&#46; Treatment with paricalcitol&#44; a selective vitamin D receptor &#40;VDR&#41; activator&#44; has shown benefits in these patients by adequately reducing PTH levels with minimal changes in serum calcium and phosphorus&#46; The aim of this study was to assess the effectiveness and safety of paricalcitol in chronic renal disease patients &#40;CKD grades 3 and 4&#41;&#46; <span class="elsevierStyleBold">Methods&#58; </span>A study of our experience with paricalcitol was conducted in normal clinical practice in patients over 18 years diagnosed with grade 3 or 4 chronic kidney disease&#46; Patients were periodically evaluated every 3 months&#46; The primary endpoint of effectiveness was to obtain two consecutive decreases of &#8805;30&#37; in iPTH with respect to baseline values&#46; The secondary endpoints were fulfilment of the objectives in accordance with the Spanish Society of Nephrology &#40;SEN&#41; and Kidney Disease Outcomes Quality Initiative &#40;K&#47;DOQI&#41; guidelines&#44; as well as the relationship between the effectiveness of the treatment and different patient variables&#46; Safety was studied by means of hypercalcaemia events&#46; <span class="elsevierStyleBold">Results&#58; </span>The primary study endpoint was achieved in 54&#46;3&#37; of patients&#46; In addition&#44; another 16&#46;3&#37; of patients had reduced iPTH by more than 30&#37; at the 3rd visit&#46; Therefore&#44; 70&#46;6&#37; of patients reduced their iPTH levels by more than 30&#37; in 6 months&#46; The relationship between treatment success and both glomerular filtration rate and body mass index was significant&#46; There were few adverse events&#44; although hypercalcaemia was found in 5&#46;4&#37; of patients&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Treatment with paricalcitol is effective in controlling secondary hyperparathyroidism in non-dialysed patients with a wide safety margin&#46;</span></p>"
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            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Slatopolsky E, Delmez JA. Pathogenesis of secondary hyperparathyroidism. Am J Kidney Dis 1994;23:229-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8311080" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Khan S. Vitamin D deficiency and secondary hyperparathyroidism among patients with chronic kidney disease. Am J Med Sci 2007;333:201-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17435411" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Bakris GL, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of anormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:31-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17091124" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martínez I, Saracho R, Montenegro J, Llach F. A deficit of calcitriol synthesis may not be the initial factor in the pathogenesis of secondary hyperparathyroidism. Nephrol Dial Transplant 1996;11(Suppl 3):22-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8840307" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Felsenfeld AJ, Rodríguez M. Phosphorus, regulation of plasma calcium, and secondary hyperparathyroidism: a hypothesis to integrate a historical and modern perspective. J Am Soc Nephrol 1999;10:878-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10203374" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004;24:503-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15452403" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Prie D, Torres PU, Friedlander G. Latest findings in phosphate homeostasis. Kidney Int 2009;75:882-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19190675" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.\u{A0}Isakova T, Gutiérrez OM, Wolf M. A blueprint for randomized trials targeting phosphorus metabolism in chronic kidney disease. Kidney Int 2009;76:705-16. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19606082" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9.\u{A0}Friedman EA. Consequences and management of hyperphosphatemia in patients with renal insufficiency. Kidney Int 2005;(Suppl):S1-S7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Michael M, García D. Secondary hyperparathyroidism in chronic kidney disease: clinical consequences and challenges. Nephrol Nurs J 2004;31:185-94."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Malluche HH, Ritz E, Range HP. Bone histology in incipient and advanced renal failure. Kidney Int 1976;9:355-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/940274" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Coen G, Mazzaferro G, Ballanti P.\u{A0}Renal bone disease in 76 patients with varying degrees of predialysis chronic renal failure: a cross-sectional study. Nephrol Dial Transplant 1996;11:813-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671900" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Giachelli CM. The emerging role of phosphate in vascular calcification. Kidney Int 2009;75:890-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19145240" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14.\u{A0}Mittman N, Desiraju B, Meyer KB, Chattopadhyay J, Avram M. treatment of secondary hyperparathyroidism in ESDR: a 2-year, single-center crossover study. Kidney Int 2010;78(Suppl 117):S33-S36."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Moe SM, Drueke TB. Management of secondary hyperparathyroidism: the importance and the challenge of controlling parathyroid hormone levels without elevating calcium, phosphorus, and calcium-phosphorus product. Am J Nephrol 2003;23:369-79. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14551461" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Goldenberg MM. Paricalcitol, a new agent for the management of secondary hyperparathyroidism in patients undergoing chronic renal dialysis. Clin Ther 1999;21:432-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10321413" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "17.\u{A0}Cozzolino M, Brancaccio D. Emerging role for the vitamin D receptor activator (VDRA), paricalcitol, in the treatment of secondary hyperparathyroidism. Expert Opin Pharmacother 2008;9:947-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18377338" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lindberg J, Martin KJ, Gonzalez EA, Acchiardo SR, Valdin JR, Soltanek C. A long-term, multicenter study of the efficacy and safety of paricalcitol in end-stage renal disease. Clin Nephrol 2001;56:315-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11680662" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martin KJ, González EA, Gellens M, Hamm LL, Abboud H, Lindberg J. 19-Nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998;9:1427-32."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cardús A, Panizo S, Parisi E, Fernández E, Valdivielso JM. Differential effects of vitamin D analogs on vascular calcification. J Bone Miner Res 2007;22:860-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17352647" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
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            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mizobuchi M, Finch JL, Martin DR, Slatopolsky E. Differential effects of vitamin D receptor activators on vascular calcification in uremic rats. Kidney Int 2007;72:709-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17597697" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Coyne D, Acharya M, Qiu P, Abboud H, Batlle D, Rosansky S, et al. Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD. Am J Kidney Dis 2006;47:263-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16431255" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "23.\u{A0}Teng M, Wolf M, Lowrie E. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003;349:446-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12890843" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY; John Willey and Sons,1989:989."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ross EA, Tian J, Abboud H, Hippensteel R, Melnick JZ, Pradhan RS. Oral paricalcitol for the treatment of secondary hyperparathyroidism in patients on hemodialysis or peritoneal dialysis. Am J Nephrol 2008;28:97-106. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17914251" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Llach F, Yudd M. Paricalcitol in dialysis patients with calcitriol-resistant secondary hyperparathyroidism. Am J Kidney Dis 2001;38:S45-S50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11689387" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sprague SM, Llach F, Amdahl M, Taccetta C, Batlle D: Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int 2003, 63: 1483-1490. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631365" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "28.\u{A0}Segura P, Borrego\u{A0} FJ, Sánchez-Perales MC, García\u{A0} MJ, Biechy MM, Pérez V. Análisis de la eficacia y de los factores que influyen en la respuesta del hiperparatiroidismo secundario de pacientes en hemodiálisis al cinacalcet. Nefrologia 2010;30(4):443-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20651886" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(Suppl. 3):S1-S201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14520607" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Torregrosa JV, Cannata J, Bover J. Recomendaciones de la Sociedad Española de Nefrología para el manejo de las alteraciones del metabolismo óseo-mineral en los pacientes con enfermedad renal crónica. Nefrologia 2011;31(Supl 1):3-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21468161" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "31.\u{A0}Al Aly Z, González EA, Martin KJ, Gellens ME. Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle. Am J Nephrol 2004;24(4):422-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15308874" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bover J, Górriz JL, Nieto J, De Francisco ALM, Barril G, Martínez-Castelao A, et al.\u{A0}¿Hemos mejorado el controlde las alteraciones del metabolismo mineral y óseo en los últimos tres años? Análisis de los datos de los estudios OSERCE I y OSERCE II. Nefrologia 2010;30(Supl 1):46."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Peña, M, Prados D, Mañero C, López Hidalgo R, Hervás JG, Cerezo S, et al.\u{A0}Estudio multicéntrico del estado del metabolismo mineral y óseo en pacientes en hemodiálisis en Andalucía 2004-2009. Nefrologia 2010;30(Supl 1):42."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mazzaferro S, Brancaccio D, Messa P, Andeucci VE. Management of secondary hyperparathyroidism in Italy: results of the Italian FARO survey. J Nephrol 2011;24(2):225-35. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21188680" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "García Agudo R, Cazalla Cadenas F. El índice de masa corporal condiciona la dosis y respuesta de paricalcitol oral en prediálisis. Nefrologia 2010;30(Supl 1):43."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "36.\u{A0}Mathews S, Lund RJ, Chaudhary LR. Vitamin D receptors activators can protect against vascular calcification. J Am Soc Nephrol 2008;19:1509-19. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18448587" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "37.\u{A0}Fishbane S, Chittineni H, Packman M. Oral paricalcitol in the treatment of patients with CKD an proteinuria: a randomized trial. Am J Kidney Dis 2009;54:647-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19596163" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "38.\u{A0}Rojas-Rivera J, De la Piedra C, Ramos A, Ortiz A, Egido J. The expanding spectrum of biological actions of vitamin D. Nephrol Dial Transplant 2010;25:2850-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20525641" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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Effectiveness of treatment with oral paricalcitol in patients with pre-dialysis chronic kidney disease
Efectividad del tratamiento con paricalcitol por vía oral en pacientes con enfermedad renal crónica en etapas anteriores a la diálisis
José Gregogio Hervás Sáncheza, José Gregorio Hervás Sánchezb, María Dolores Prados Garridob, Aurora Polo Moyanob, Sebastian Cerezo Moralesb
a Servicio de Nefrología, H. Universitario San Cecilio, Granada, Spain,
b Servicio de Nefrología, H. Universitario San Cecilio, Granada,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Secondary hyperparathyroidism &#40;SHPT&#41; is a frequent and early complication of patients with chronic kidney disease &#40;CKD&#41;&#44; characterised by increased levels of parathyroid hormone &#40;PTH&#41;&#46; It is usually accompanied by hyperplasia of the parathyroid glands as well as high morbidity&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">Metabolic changes of this disorder are caused by a progressive loss of renal mass and a decline in the glomerular filtration rate &#40;GFR&#41;&#46; During progressive renal failure&#44; PTH increases in inverse proportion to the decrease in GFR&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The pathogenesis of SHPT has long been attributed to 3 main factors&#58; calcitriol deficiency&#44; hyperphosphataemia and hypocalcaemia&#46;</p><p class="elsevierStylePara">According to some observations&#44; in early stages of CKD &#40;GFR &#62;70 ml&#47;min&#41;&#44; an increase of phosphoraemia&#44; detected only after phosphorus overload following ingestion&#44; explains the early onset of SHPT&#46;<span class="elsevierStyleSup">4</span> Moreover&#44; the decrease in calcium and occasional increases in phosphorus have an undeniable role in stimulating the parathyroid glands&#46; However&#44; it is regularly seen in clinical practice that the levels of serum calcium and phosphorus are within normal range until the relatively advanced stages of CKD&#46;<span class="elsevierStyleSup">3-6</span></p><p class="elsevierStylePara">Furthermore&#44; a new pathogenic factor&#44; FGF23 &#40;Fibroblast Growth Factor 23&#41; has been discovered in recent years&#46; Although not many details are known about its mechanism of action&#44; this phosphatonin&#44; synthesised primarily in the bone&#44; helps to prevent a hypothetical phosphorus overload via its phosphaturic action while decreasing the synthesis of calcitriol&#46;<span class="elsevierStyleSup">7&#44;8</span></p><p class="elsevierStylePara">SHPT and mineral metabolism disorders have 2 main types of clinical consequences&#58; the first in the musculoskeletal system and the second in the cardiovascular system&#46; The first is due to increased bone remodelling&#44; whose usual injury is fibrous osteitis&#44; with a loss of bone mass and structural integrity of the bones&#46;<span class="elsevierStyleSup">9&#44;10</span> These renal osteodystrophy lesions have been documented via bone biopsies in very early stages of CKD&#46;<span class="elsevierStyleSup">11&#44;12</span> The second is associated with an increased risk of cardiovascular calcification&#44; with vascular toxicity playing an important part&#46;<span class="elsevierStyleSup">9&#44;10&#44;13&#44;14</span></p><p class="elsevierStylePara">The usual treatment for SHPT includes restriction of dietary phosphorus&#44; phosphorus binders and administration of vitamin D receptor activators&#46; More recently&#44; calcimimetic cinacalcet has been added to the therapeutic arsenal&#46; This activates the calcium receptor and inhibits PTH secretion&#44; in addition to having other effects&#46;</p><p class="elsevierStylePara">Calcitriol is the most frequently used vitamin D analogue&#46; However&#44; available data shows it to have the significant disadvantage of increasing the absorption of calcium and phosphorus&#44; with the consequent risk of hypercalcaemia&#46; This may lead to increased vascular calcification and an increased cardiovascular mortality risk in certain circumstances&#46;<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara">Therefore&#44; new drugs to activate the vitamin D receptor have been developed with less effect on the intestinal absorption of calcium and phosphorus&#46; Paricalcitol is a third-generation drug that selectively activates the vitamin D receptor &#40;VDR&#41;&#44; depending on the tissue&#46;<span class="elsevierStyleSup">16</span></p><p class="elsevierStylePara">It has been shown experimentally to suppress PTH secretion&#44; but with minimal changes in calcaemia and phosphoraemia&#46;<span class="elsevierStyleSup">17-19</span> Moreover&#44; there is evidence in animal models showing that treatment with paricalcitol does not increase the expression of procalcifying markers in vascular smooth muscle cells&#46; This does not happen with vitamin D analogues&#44; which do overexpress some of these markers&#44; increasing vascular calcification&#46; This vascular calcification protective effect&#44; typical of paricalcitol&#44; is independent of serum calcium&#44; phosphorus or PTH&#46;<span class="elsevierStyleSup">20&#44;21</span></p><p class="elsevierStylePara">Several clinical trials and post-authorisation studies have shown that paricalcitol is able to control the effects of SHPT with less hypercalcaemia and hyperphosphataemia than calcitriol in haemodialysis patients&#46;<span class="elsevierStyleSup">14-26</span> One well-known study observed an increase in survival after a 2-year follow-up for haemodialysis patients who switched to paricalcitol from calcitriol&#46;<span class="elsevierStyleSup">23</span></p><p class="elsevierStylePara">Another reason for this study was the current lack of clinical experience of non-dialysis patients with early hyperparathyroidism treated with paricalcitol&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient selection</span></p><p class="elsevierStylePara">Those included were stable patients over 18 years of age&#44; without concomitant severe disease&#44; with an established grade 3 or 4 diagnosis of CKD&#46; They were referred for the first time to the Nephrology Department of the San Cecilio Clinical Hospital&#44; Granada from primary care or another consultation in our hospital between October 2008 and June 2010&#46;</p><p class="elsevierStylePara">The inclusion criteria were to present SHPT with intact parathyroid hormone &#40;iPTH&#41; values &#62;70 pg&#47;ml for patients with CKD grade 3 and iPTH &#62;110 pg&#47;ml in patients with CKD grade 4&#46; Patients were excluded if they had total serum calcium&#62;9&#46;5 mg&#47;dl or had received treatment with vitamin D&#44; vitamin D analogues&#44; phosphate binders&#44; calcium salts&#44; drugs that might alter calcium or bone metabolism such as bisphosphonates and&#47;or calcitonin in the previous 6 months&#46; Patients with significant comorbidity or an inability to continue treatment were also excluded&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives and endpoints</span></p><p class="elsevierStylePara">The objective was to establish the effectiveness and safety of oral paricalcitol administration in patients with CKD grades 3 and 4 &#40;estimated MDRD GFR of 59-30ml&#47;min&#47;1&#46;73m&#178; and 29-15ml&#47;min&#47;1&#46;73m&#178;&#44; respectively&#41; under the usual clinical practice conditions at our hospital&#46; We retrospectively analysed our clinical experience by considering the main analysis variable as the effectiveness of oral paricalcitol&#44; as described previously&#44; in achieving 2 consecutive reductions of 30&#37; or more from baseline iPTH&#46;</p><p class="elsevierStylePara">The secondary effectiveness variable analysed was the percentage of patients who fulfilled the Spanish Society of Nephrology &#40;SEN&#41; and the Kidney Foundation Disease Outcomes Quality Initiative &#40;K&#47;DOQI&#41; guidelines&#46; These included iPTH &#60;70pg&#47;ml &#40;CRD 3&#41; and iPTH &#60;110pg&#47;ml &#40;CRD 4&#41;&#44; with calcium in the range 8&#46;4-9&#46;5mg&#47;dl and phosphorus in the range 2&#46;7-4&#46;6mg&#47;dl&#46;</p><p class="elsevierStylePara">In addition&#44; the relationship between treatment success and different patient variables were analysed&#46;</p><p class="elsevierStylePara">The primary safety variable in the study was the follow-up of total calcium values to detect the presence of hypercalcaemia with a total calcium &#62;10&#46;5mg&#47;dl&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Follow-up and medication procedures</span></p><p class="elsevierStylePara">The treatment follow-up was retrospective analysis at 6 months by comparing data from the baseline visit &#40;V1&#41; with two successive visits with a 3-month interval&#44; V2 &#40;second visit&#41; and V3 &#40;third visit&#41;&#46; The diagnosis&#44; prescription and follow-up were carried out by a single doctor&#46;</p><p class="elsevierStylePara">The initial dose of paricalcitol was determined according to the baseline concentrations of iPTH described in another study&#46;<span class="elsevierStyleSup">22</span> A daily dosing regimen was chosen&#44; with an initial dose of 1&#181;g per day when the iPTH was &#8804;500pg&#47;ml&#44; and 2&#181;g per day when &#8805;500pg&#47;ml&#46;<span class="elsevierStyleSup">22</span></p><p class="elsevierStylePara">At the following quarterly visits&#44; the dose was modified according to the iPTH response following the usual method in our clinic&#46; If the reduction of iPTH was &#60;15&#37;&#44; the dose was doubled&#59; if the reduction was between 30&#37; and 60&#37;&#44; it was maintained&#59; and if the reduction was &#62;60&#37;&#44; it was halved&#46; If serum calcium was &#62;10&#46;2mg&#47;dl&#44; the dose was reduced&#44; and if it was &#62;10&#46;5mg&#47;dl&#44; the medication was temporarily suspended&#46; Fortnightly determinations of calcium were then performed and the therapy restarted after normalisation of serum calcium&#46;</p><p class="elsevierStylePara">Patient clinical data from the central computerised and centralised hospital medical records was taken and analysed statistically&#46; They included the age&#44; sex&#44; body mass index &#40;BMI&#41;&#44; CKD etiology&#44; concomitant treatments&#44; serum calcium level&#44; serum phosphorus&#44; total cholesterol&#44; HDL cholesterol&#44; LDL cholesterol&#44; triglycerides&#44; haemoglobin&#44; calculated creatinine clearance&#44; Cockroft-Gault GFR&#44; estimated MDRD GFR and calcidiol levels &#40;25-OH vitamin D&#41;&#46; Patients were asked beforehand for permission to use these data for the computer analysis via a data confidentiality agreement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Laboratory methods</span></p><p class="elsevierStylePara">Total calcium and phosphorus serum levels&#44; as well as the other analytical parameters&#44; were measured with an autoanalyser according to hospital laboratory procedures&#46; The calcium values in this study were expressed as uncorrected total calcium levels with serum protein or albumin levels&#46; PTH was determined by electrochemiluminescence &#40;EQL Elecsys PTH&#44; Roche&#41;&#44; and the results corrected with the coefficient 0&#46;97 to express them as IRMA NICHOLS according to the K&#47;DOQI guidelines&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">A descriptive analysis of the categorical variables was conducted by calculating the frequency of each&#46; For quantitative variables&#44; the mean and standard deviation were calculated when the distribution was normal&#59; and the median and interquartile range when the distribution was not normal&#46; Some quantitative variables were categorised&#46;</p><p class="elsevierStylePara">Statistical significance was assessed using the chi-square test &#40;for categorical variables&#41;&#44; Student&#39;s t test or the nonparametric Wilcoxon test as appropriate &#40;for quantitative variables&#41;&#46; The univariate association analysis was performed using the chi-square test&#44; Student&#39;s t-test or the Mann-Whitney U test&#46;</p><p class="elsevierStylePara">The relationship between treatment success and different variables was analysed in a univariate or multivariate logistic regression&#46; The goodness of fit was assessed by the Hosmer and Lemeshow test&#46;<span class="elsevierStyleSup">24</span></p><p class="elsevierStylePara">Calcium and phosphorus levels were measured to evaluate the safety of the treatment by analysing the appearance of hypercalcaemia or hyperphosphataemia&#46; Calcaemia was categorised into four levels as follows&#58; &#8804;8&#46;5mg&#47;dl&#44; &#62;8&#46;5 and &#8804;9&#46;5mg&#47;dl&#44; &#62;9&#46;5 and &#8804;10&#46;5mg&#47;dl and &#62;10&#46;5mg&#47;dl&#46; The distribution of patients in each category was studied&#46; Also&#44; the presentation of moderate hypercalcaemia was analysed &#40;percentage of patients with a value &#62;10&#46;2mg&#47;dL in at least one visit&#41;&#44; which resulted in the dose having to be reduced&#44; and significant hypercalcaemia &#40;percentage of patients with a value &#62;10&#46;5mg&#47;dl&#41; that forced the temporary suspension of treatment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Demographic and baseline parameters</span></p><p class="elsevierStylePara">Initially&#44; 99 patients who met the inclusion criteria were selected&#44; 7 of whom had incomplete data at 6 months &#40;1 for voluntarily discontinuing treatment and 6 because the follow-up was lost before the 3rd visit&#41;&#46; Therefore&#44; the final analysis was of 92 patients who had completed 6 months treatment&#46;</p><p class="elsevierStylePara">The mean age was 73&#177;11 years&#44; and 50&#37; were women&#46; There was a higher frequency of moderate CKD &#40;55&#46;4&#37; with CKD 3&#41; than serious CKD &#40;44&#46;5&#37; with CKD 4&#41;&#46; The most frequent etiology of CKD was diabetes &#40;33&#46;7&#37;&#41;&#44; followed by vascular &#40;27&#46;6&#37;&#41;&#44; interstitial &#40;5&#46;1&#37;&#41; and polycystic kidney disease &#40;3&#46;1&#37;&#41;&#46; There were 28&#46;6&#37; of cases with unknown etiology&#46; The mean body mass index &#40;BMI&#41; was 30&#46;6&#177;6&#44; indicating an overweight population&#46; The mean total cholesterol was 182&#46;3&#177;44mg&#47;dl&#44; HDL cholesterol was 51&#46;3&#177;15mg&#47;dl and LDL cholesterol was 103&#46;2&#177;33mg&#47;dL&#44; which meant a relatively controlled lipid profile in most patients&#46; There were 35&#46;7&#37; of patients under treatment with angiotensin-converting enzyme &#40;ACE&#41; inhibitors and 42&#46;9&#37; with angiotensin II receptor antagonists &#40;ARBs&#41; for associated hypertension &#40;HT&#41;&#44; see Table 1&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Analysis of treatment effectiveness</span><span class="elsevierStyleBold"></span></p><p class="elsevierStylePara">The planned review sequence was quarterly&#44; with the average actual time being 11&#46;7&#177;3 weeks for the second visit &#40;V2&#41; and 25&#46;6&#177;6 weeks for the third &#40;V3&#41;&#46;</p><p class="elsevierStylePara">The mean paricalcitol doses administered at the 3 study times were as follows&#58; at the baseline visit&#44; patients were prescribed 7&#46;4&#177;2&#46;4mg&#47;week&#44; at the 2nd visit it was 6&#46;8&#177;2&#46;4mg&#47;week and in the 3rd visit it was 5&#46;2&#177;3&#46;2mg&#47;week&#46;</p><p class="elsevierStylePara">The primary outcome of the study was achieved in 54&#46;3&#37; of patients&#44; who had a reduction of &#8805;30&#37; in iPTH levels at the 2nd visit &#40;V2&#44; 3 months&#41; which was maintained at the 3rd visit &#40;V3&#44; 6 months&#41;&#46; In addition&#44; another 16&#46;3&#37; of patients achieved a decrease of &#8805;30&#37; in iPTH levels at the 3rd visit &#40;V3&#41;&#46; Thus&#44; 70&#46;6&#37; of all patients had decreased their iPTH by over 30&#37; at 6 months&#44; compared to baseline&#46;</p><p class="elsevierStylePara">As the iPTH values did not follow a normal distribution&#44; they were expressed as median and interquartile range &#40;Figure 1&#41;&#46; The median iPTH shows a statistically significant decrease of 33&#46;1&#37; between baseline &#40;V1&#41; and the 2nd visit &#40;V2&#41;&#44; from 163 to 109pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#46; There was also a statistically significant change between the 2nd &#40;V2&#41; and 3rd &#40;V3&#41; visits&#58; decreasing by 25&#46;2&#37; from 109 to 81&#46;5pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#46; Overall&#44; for all patients&#44; over 6 months of the study&#44; the median iPTH decreased significantly by 50&#46;0&#37;&#44; from 163 to 81&#46;5pg&#47;ml &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; see Table 2 and Figure 1&#46;</p><p class="elsevierStylePara">The reductions in iPTH allowed a proportionately lower dose of paricalcitol to be used&#44; from 7&#46;4&#177;2&#46;4 to 6&#46;8&#177;3&#46;08&#181;g&#47;week &#40;V2&#41; and 5&#46;2&#177;3&#46;2&#181;g&#47;week &#40;V3&#41;&#46;</p><p class="elsevierStylePara">As a secondary objective&#44; the treatment effectiveness was analysed according to the K&#47;DOQI guidelines&#44; which took into account the calcium and phosphorus values&#44; in addition to PTH&#46; The proportions of patients meeting these target levels at 6 months were&#58; iPTH 31&#46;6&#37;&#44; calcium 69&#46;6&#37; and phosphorus 58&#46;7&#37;&#44; although only 26&#46;1&#37; of patients achieved all these objectives simultaneously &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara">Variations in total serum calcium &#40;baseline 9&#46;0&#177;0&#46;5mg&#47;dl and end 9&#46;2&#177;0&#46;7mg&#47;dl&#41; were not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;12&#41;&#46; Similarly&#44; changes in serum phosphorus &#40;baseline 3&#46;5&#177;0&#46;6mg&#47;dl and final 3&#46;6&#177;0&#46;6mg&#47;dl&#41; were not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;2&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara">The different renal function calculations also showed no significant changes&#58; diuresis &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41;&#44; Cockroft-Gault GFR &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41; and MDRD GFR &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;7&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara">We also observed small variations in the levels of calcidiol&#44; which are likely to reflect the seasonal changes due to the different times of year analysed&#46; Their values increased slightly from 16&#46;2&#177;8ng&#47;ml to 18&#46;2&#177;10ng&#47;ml&#44; which was not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;13&#41;&#44; see Table 2&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Relationship between treatment effectiveness and diabetes and chronic kidney disease grade</span></p><p class="elsevierStylePara">There were no significant differences in the primary endpoint for diabetic and non-diabetic patients&#44; with the objective being achieved in 56&#46;2&#37; of diabetics and 53&#46;3&#37; of non-diabetics&#46;</p><p class="elsevierStylePara">Significant differences were detected in the relationship between effectiveness and CKD grade&#44; as the primary endpoint was achieved in 67&#37; of patients with CKD 4 versus 44&#37; of those with CKD 3 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;05&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Other factors associated with effectiveness&#58; univariate and multivariate associations</span></p><p class="elsevierStylePara">The univariate logistic regression analysis found a significant positive association between the main efficacy variable &#40;probability of treatment success&#41; and increased renal affectation &#40;CKD 4 vs&#46; CKD 3&#41; &#91;odds ratio &#40;OR&#41; of 2&#46;52&#59; 95&#37; confidence interval &#40;CI&#41; of 1&#46;07-5&#46;97&#93; and higher baseline iPTH levels &#40;OR 1&#46;02&#59; 95&#37; CI&#58; 1&#46;01-1&#46;03&#41;&#46; While the probability of treatment success was lower for a higher BMI &#40;OR 0&#46;87&#59; 95&#37; CI&#58; 0&#46;79-0&#46;95&#41;&#44; higher creatinine clearance &#40;OR 0&#46;97&#59; 95&#37; CI 0&#46;93-0&#46;99&#41; and increased GFR estimate by Cockroft-Gault &#40;OR 0&#46;95&#59; 95&#37; CI&#58; 0&#46;91-0&#46;99&#41;&#46;</p><p class="elsevierStylePara">In the multivariate logistic regression analysis&#44; baseline iPTH was chosen as an explanatory variable&#44; as it was the most statistically significantly successful parameter for the goal of the study&#46; Also&#44; BMI was included in the multivariate model as an additional variable&#44; and the equation was adjusted for the variables of sex and age&#46; The resulting model showed a good fit&#46; The result was an increase of 2&#37; treatment success for each unit increase in baseline iPTH &#40;OR 1&#46;02&#59; 95&#37; CI&#58; 1&#46;01-1&#46;03&#41;&#44; and a decrease of 17&#37; for each unit increase in BMI &#40;OR 0&#46;83&#59; 95&#37; CI&#58; 0&#46;75-0&#46;93&#41;&#46; In both cases&#44; the results were independent of the age or sex of patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatment Safety</span></p><p class="elsevierStylePara">Most patients had serum calcium levels between 8&#46;5 and 9&#46;5mg&#47;dl during follow-up&#58; 72&#46;4&#37; at the 2nd visit &#40;V2&#41; and 69&#46;6&#37; at the 3rd visit &#40;V3&#41;&#46; Only 2 patients &#40;2&#46;1&#37;&#41; had calcium levels above 10&#46;5mg&#47;dl&#46; Moreover&#44; 5 patients &#40;5&#46;4&#37;&#41; were observed with calcium levels above 10&#46;2mg&#47;dl &#40;1 case at V2 and 4 cases at V3&#41;&#46;</p><p class="elsevierStylePara">Also&#44; calcium values below 8&#46;5mg&#47;dl were observed in 9&#46;2&#37; of patients at V2 and 8&#46;7&#37; of patients at V3&#46;</p><p class="elsevierStylePara">Variations in the mean calcium and phosphorus during the study were not statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Other adverse effects</span></p><p class="elsevierStylePara">Seemingly transient symptoms of nausea and&#47;or vomiting attributed to the drug were found in 3 patients &#40;3&#46;06&#37;&#41;&#44; who were receiving numerous medications&#46; However&#44; because of their transitory nature&#44; it was not necessary to discontinue the medication&#46;</p><p class="elsevierStylePara">One patient &#40;1&#46;02&#37;&#41;&#44; also being administered many drugs simultaneously&#44; dropped out of treatment at the 3rd visit voluntarily&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The data collected in this study from our consulting practice&#44; and those applied retrospectively to patients with similar criteria in the literature&#44; show a high effectiveness for paricalcitol in controlling SHPT in patients with CKD stages 3 and 4 when administered in a daily regimen&#44; with no significant changes in calcaemia or phosphoraemia&#46;</p><p class="elsevierStylePara">There was a significant decrease of 50&#46;0&#37; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; in median iPTH in our patients from baseline &#40;163pg&#47;ml&#41; to the end of the study &#40;81&#46;5 pg&#47;ml&#41;&#46; This significant reduction fulfilled the main objective of the study for 54&#46;3&#37; of patients who achieved &#8805;30&#37; reductions in iPTH levels at 3 months and maintained this decrease at 6 months&#59; ie&#44; they had 2 consecutive decreases compared to baseline&#46; Our results are smaller in magnitude than those in Coyne&#39;s study&#44; where 90&#37; of patients achieved a similar objective&#46;<span class="elsevierStyleSup">22</span> We believe these differences are due to the different study conditions&#46; Coyne&#39;s study was a controlled clinical trial with a prospectively determined primary objective&#44; while ours was limited by the conditions in a normal hospital clinic and the data were studied retrospectively&#46; Furthermore&#44; Coyne&#39;s study was based on PTH levels greater than ours&#44; therefore patients received mean doses of paricalcitol larger than ours&#46; Finally&#44; the time intervals and follow-up times were also different&#46;</p><p class="elsevierStylePara">Another aspect observed in our patients was that there was a greater reduction &#40;35&#46;5&#37; vs 24&#46;4&#37;&#41; in iPTH between baseline &#40;V1&#41; and the 2nd visit &#40;V2&#41; than between the 2nd &#40;V2&#41; and 3rd visits &#40;V3&#41;&#46; This is consistent with previous studies which have shown decreases in iPTH levels of 30&#37; in the first 2 months with progressively less decreases in the following months&#46;<span class="elsevierStyleSup">18&#44;22&#44;25</span> In total&#44; we observed a median decrease of 50&#46;0&#37; in iPTH from baseline levels until the end of study &#40;V1 to V3&#41;&#46; This meant that 70&#46;6&#37; of patients reduced their iPTH by more than 30&#37; over 6 months&#46;</p><p class="elsevierStylePara">This reduction compares favourably with similar studies&#46; In a long-term open multicentre study for oral paricalcitol&#44; a progressive decrease in iPTH was seen up to the 13th month of treatment&#46;<span class="elsevierStyleSup">25</span> In other studies&#44; the effects of paricalcitol were compared with calcitriol&#44; a non-selective vitamin D analogue&#44; and significantly larger and faster decreases in iPTH were observed with paricalcitol than with calcitriol&#46;<span class="elsevierStyleSup">26&#44;27</span> Another recent study conducted with 40&#46;5&#37; of patients receiving cinacalcet in haemodialysis associated with paricalcitol&#44; experienced a 50&#37; reduction in PTH&#44; which was comparable to our patients who only received paricalcitol&#46;<span class="elsevierStyleSup">28</span></p><p class="elsevierStylePara">Moreover&#44; the significant decreases in iPTH in our patients allowed the paricalcitol dose to be gradually reduced from a weekly average of 7&#46;4g at the start to an average of 5&#46;2&#181;g at the end&#44; with the maximum degree of iPTH control&#46; This is a 29&#46;7&#37; reduction in the dose over the 6 months of the study&#44; as found by other authors&#46; In an open&#44; long-term prospective study&#44; the paricalcitol dose was significantly reduced throughout the study while maintaining suppression of the iPTH&#46;<span class="elsevierStyleSup">26</span></p><p class="elsevierStylePara">Another way to analyse the treatment effects on mineral metabolism disorders is to evaluate compliance with values considered optimal by different clinical practice guidelines&#44; such as the K&#47;DOQI guidelines proposed by the American National Kidney Foundation<span class="elsevierStyleSup">29</span> and the SEN guidelines&#46;<span class="elsevierStyleSup">30</span> According to both guidelines&#44; 31&#46;6&#37; of our patients were within the range for iPTH&#44; 66&#46;9&#37; were within the range for calcaemia and 58&#46;7&#37; were within the range for phosphoraemia at the end of the study period&#46; Also&#44; 26&#46;1&#37; of patients managed all 3 parameter targets simultaneously&#46; It should be noted that the iPTH level treatment algorithm for our patients was not designed prospectively to achieve the margins proposed by these guidelines&#46;</p><p class="elsevierStylePara">The difficulty in complying with the K&#47;DOQI criteria has long been known&#44; and has been described as a &#8220;painful&#8221; or &#8220;uphill&#8221; battle&#46; They had scarcely been published&#44; when it was found that few patients were meeting them&#46; One of the first studies&#44; in haemodialysis patients&#44; found 20&#37; of patients complying with iPTH levels and only 8&#37; for all 3 parameters simultaneously&#46;<span class="elsevierStyleSup">31</span> In the Spanish SEN multicentre study&#44; OSERCE II&#44; which included patients with CKD not on dialysis in 39 centres&#44; it was found that 30&#37; were within the K&#47;DOQI range for PTH&#44; 35&#46;6&#37; for calcium and 76&#46;5&#37; for phosphorus&#46; This study highlighted the difficulty of reducing the PTH&#44; especially when compared with another similar study of 3 years earlier by the same authors&#44; which achieved a similar decrease in PTH&#46;<span class="elsevierStyleSup">32</span> Similarly&#44; another study in our group collected data from the Sistema de Informaci&#243;n de Coordinaci&#243;n Auton&#243;mica de Trasplante Andaluza &#40;Andalusian Transplant Autonomy Coordination Information System&#44; SICATA&#41; for the years 2007&#44; 2008 and 2009 concerning the control of PTH according to the K&#47;DOQI guidelines in haemodialysis patients&#46; The percentage within the range for iPTH was 32&#46;4&#37; &#40;in 2007 and 2008&#41; and 35&#37; &#40;in 2009&#41;&#46; It should also be noted that between 13&#46;5&#37; and 15&#37; of patients were within the range simultaneously for all 3 parameters&#58; calcium&#44; phosphorus and PTH&#46;<span class="elsevierStyleSup">33</span> Finally&#44; a multicentre Italian study &#40;Italian FARO Survey&#41;&#44; involving 2&#44;637 patients from 28 haemodialysis centres&#44; also showed the difficulty in complying with the K&#47;DOQI guidelines&#46; There were 26&#46;8&#37; of patients within the iPTH range at baseline and 32&#37; at 18 months&#46;<span class="elsevierStyleSup">34</span> Thus&#44; these studies illustrate the difficulty in achieving the guideline objectives for both dialysis and in CKD not on dialysis&#46;</p><p class="elsevierStylePara">Moreover&#44; as a secondary aim in our study&#44; we evaluated the various factors that could influence the response to treatment&#46; There was no difference between diabetic &#40;56&#46;2&#37; success&#41; and non-diabetic patients &#40;53&#46;3&#37; success&#41; regarding a decrease &#8805;30&#37; in iPTH levels</p><p class="elsevierStylePara">However&#44; the treatment was more effective in patients with CKD grade 4 than those with grade 3&#44; for both the primary endpoint and secondary measures &#40;reduction in iPTH in at least 1 visit&#41;&#46; In addition&#44; logistic regression results confirmed an association between treatment effectiveness and the CKD grade &#40;greater effectiveness in CKD grade 4&#44; lower creatinine clearance&#44; lower Cockroft estimate or lower MDRD&#41;&#46; One possible explanation is that it is more difficult to lower iPTH to a normal range the closer you are to it&#44; and easier the farther away&#44; at least in early hyperparathyroidism where there is only diffuse hyperplasia of the parathyroid glands and they are sufficiently sensitive to the activation of the vitamin D receptor &#40;VDR&#41;&#46;</p><p class="elsevierStylePara">The association with BMI showed that the higher this was&#44; the lower the likelihood of treatment success&#46; Other authors in a recent paper also noted that a higher BMI had a worse response to oral paricalcitol in renal failure before dialysis&#44; and that obesity is a factor in poor treatment response as was seen in our patients&#46;<span class="elsevierStyleSup">35</span></p><p class="elsevierStylePara">Analysis by a multivariate model showed similar results&#44; ie&#44; that the effectiveness of treatment increased with higher baseline iPTH level and decreased with increasing BMI&#46;</p><p class="elsevierStylePara">Finally&#44; the most common risks of treating patients with CKD grades 3 or 4 with vitamin D analogues are causing hypercalcaemia&#44; hyperphosphataemia and increased Ca x P product&#46; It is known that selective activation of VDRs&#44; as happens with paricalcitol&#44; lowers intestinal absorption of these ions&#44; significantly decreasing these risks&#44; as seen in the Coyne study&#46;<span class="elsevierStyleSup">22</span> It emerged from our study&#44; that treatment with paricalcitol&#44; in addition to its effectiveness&#44; leads to safe management of the drug&#44; as only 5 cases of moderate hypercalcaemia &#62;10&#46;2mg&#47;dl &#40;5&#46;4&#37; of patients&#41; were seen&#44; which represented 2&#46;6&#37; of all analytical results at the 6 months follow-up&#46; Moreover&#44; 2 cases &#40;2&#46;1&#37; of patients&#41; had severe hypercalcaemia &#62;10&#46;5mg&#47;dl which forced the temporary suspension of the drug&#46; As reported in other studies&#44;<span class="elsevierStyleSup">22</span> a slight average increase in calcium levels of 0&#46;1-0&#46;2mg&#47;dl was seen&#44; which is not statistically significant&#46; There were no significant changes in levels of phosphorus&#44; nor any determination with hyperphosphataemia&#46; Our data are comparable to those of other studies&#44; where the incidence of adverse effects&#44; hypercalcaemia&#44; hyperphosphataemia and high calcium-phosphorus product was similar in both the paricalcitol group and placebo group patients&#46;<span class="elsevierStyleSup">14&#44;22&#44;25&#44;26</span> Given the particular importance that selective activation of VDR is acquiring&#44; in both vascular calcification protection<span class="elsevierStyleSup">36</span> and its potential pleiotropic effects&#44;<span class="elsevierStyleSup">37&#44;38</span> we believe our experience with this drug could be particularly useful&#44; in terms of effectiveness and safety&#46;</p><p class="elsevierStylePara">Another problem that must be taken into account with treatments is the global tolerance to these substances&#46; In our study&#44; it was observed that paricalcitol was well tolerated&#46; Adverse effects&#44; which were mainly gastrointestinal&#44; were very few&#44; mild and were resolved in a few weeks without discontinuing the treatment&#46; Only 3 patients &#40;3&#46;06&#37;&#41; were affected&#59; while 1 patient &#40;1&#46;02&#37;&#41;&#44; taking plenty of other medications&#44; discontinued treatment by choice due to feeling generally unwell and nauseous without vomiting&#46; None of the analytical tests showed any abnormality to explain the symptoms the patient reported&#46; Similar data are found in other studies&#46;<span class="elsevierStyleSup">14&#44;22</span></p><p class="elsevierStylePara">In conclusion&#44; our data suggest that under the routine clinical practice conditions in our clinic&#44; oral paricalcitol can be used as a treatment of choice in early hyperparathyroidism for patients with CKD stages 3 and 4&#46; There is a sufficient degree of efficiency&#44; safety and tolerance&#44; and clinical results comparable to those of published controlled trials could be expected&#46;</p><p class="elsevierStylePara">The main effort in this study was to try to apply the skills of rigorous&#44; prospective studies with a control group to normal clinical practice&#46; Therefore&#44; the difficulty in validating our data&#44; due to few previous studies in clinical practice conditions similar to ours&#44; is recognized as a study limitation&#46; A second limitation is the small number of patients treated&#44; and a third is the lack of a longer-term follow-up&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;16025&#95;23734&#95;en&#95;t1&#95;11030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_16025_23734_en_t1_11030.jpg" alt="Demographic and baseline parameters"></img></a></p><p class="elsevierStylePara">Table 1&#46; Demographic and baseline parameters</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23735&#95;en&#95;t211030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23735_en_t211030.jpg" alt="Changes in key variables in the 3 visits"></img></a></p><p class="elsevierStylePara">Table 2&#46; Changes in key variables in the 3 visits</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23736&#95;en&#95;f111030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23736_en_f111030.jpg" alt="iPTH values &#40;expressed as median and interquartile range&#41;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; iPTH values &#40;expressed as median and interquartile range&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11030&#95;108&#95;23737&#95;en&#95;f211030&#46;jpg" class="elsevierStyleCrossRefs"><img src="11030_108_23737_en_f211030.jpg" alt="Percentage of patients after 6 months treatment meeting the K&#47;DOQI guideline values for calcium&#44; phosphorus and iPTH"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Percentage of patients after 6 months treatment meeting the K&#47;DOQI guideline values for calcium&#44; phosphorus and iPTH</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n y objetivos&#58; </span>El hiperparatiroidismo secundario es una complicaci&#243;n habitual en pacientes con insuficiencia renal cr&#243;nica&#46; El tratamiento con paricalcitiol&#44; activador selectivo del receptor de vitamina D&#44; ha demostrado tener beneficios en el tratamiento de estos pacientes al disminuir adecuadamente la hormona paratiroidea &#40;PTH&#41; con m&#237;nimas variaciones del calcio y f&#243;sforo s&#233;ricos&#46;&#160;El objetivo de este estudio es evaluar la efectividad y la seguridad del paricalcitol en el tratamiento de pacientes con insuficiencia renal cr&#243;nica &#40;ERC 3 y 4&#41;&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Se llev&#243; a cabo un an&#225;lisis de datos de nuestra experiencia&#44; en condiciones de pr&#225;ctica cl&#237;nica habitual&#44; en 92 pacientes de m&#225;s de 18 a&#241;os con diagn&#243;stico de ERC de grado 3 y 4&#46; Los pacientes incluidos en el mismo fueron tratados con paricalcitol y evaluados mediante controles peri&#243;dicos cada tres meses&#46; Como medida principal de efectividad se estableci&#243; la obtenci&#243;n&#160;de dos disminuciones en visitas consecutivas &#8805;del 30&#37; de la hormona paratiroidea intacta &#40;PTHi&#41; respecto a las cifras basales&#46; Se analizaron como objetivos secundarios el cumplimiento de los objetivos de acuerdo con las gu&#237;as de la Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;S&#46;E&#46;N&#46;&#41;&#160;y Kidney Diseases Outcome Quality Initiatives&#160;&#40;K&#47;DOQI&#41;&#44; y&#44; tambi&#233;n&#44; la relaci&#243;n entre la efectividad del tratamiento y las diferentes variables registradas de los pacientes&#46;&#160;La variable principal de seguridad estudiada fue la aparici&#243;n de hipercalcemia&#46; <span class="elsevierStyleBold">Resultados&#58; </span>El objetivo principal del estudio lo cumplieron el 54&#44;3&#37; &#160;de los pacientes&#46; Adicionalmente&#44; en otro 16&#44;3&#37; de los pacientes disminuy&#243; la PTHi m&#225;s del 30&#37; al llegar a la tercera visita &#40;a los seis meses&#41;&#46; En conjunto&#44; un 70&#44;6&#37; de los pacientes hab&#237;an conseguido reducir m&#225;s del 30&#37; los niveles de PTHi&#160; a los seis meses con el tratamiento con paricalcitol&#46; La relaci&#243;n entre el &#233;xito del tratamiento y el grado de filtrado glomerular fue significativa&#44; as&#237; como su relaci&#243;n con el &#237;ndice de masa corporal&#46; Apenas hubo efectos adversos&#59; se hall&#243;&#160;hipercalcemia en un 2&#44;1&#37; de los pacientes&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>El tratamiento con paricalcitol presenta una buena efectividad en el control del hiperparatiroidismo secundario en pacientes no en di&#225;lisis&#44; bajo condiciones de pr&#225;ctica cl&#237;nica habitual con un alto grado de seguridad&#46;&#160;</p>"
      ]
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Purpose&#58; </span>Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease&#46; Treatment with paricalcitol&#44; a selective vitamin D receptor &#40;VDR&#41; activator&#44; has shown benefits in these patients by adequately reducing PTH levels with minimal changes in serum calcium and phosphorus&#46; The aim of this study was to assess the effectiveness and safety of paricalcitol in chronic renal disease patients &#40;CKD grades 3 and 4&#41;&#46; <span class="elsevierStyleBold">Methods&#58; </span>A study of our experience with paricalcitol was conducted in normal clinical practice in patients over 18 years diagnosed with grade 3 or 4 chronic kidney disease&#46; Patients were periodically evaluated every 3 months&#46; The primary endpoint of effectiveness was to obtain two consecutive decreases of &#8805;30&#37; in iPTH with respect to baseline values&#46; The secondary endpoints were fulfilment of the objectives in accordance with the Spanish Society of Nephrology &#40;SEN&#41; and Kidney Disease Outcomes Quality Initiative &#40;K&#47;DOQI&#41; guidelines&#44; as well as the relationship between the effectiveness of the treatment and different patient variables&#46; Safety was studied by means of hypercalcaemia events&#46; <span class="elsevierStyleBold">Results&#58; </span>The primary study endpoint was achieved in 54&#46;3&#37; of patients&#46; In addition&#44; another 16&#46;3&#37; of patients had reduced iPTH by more than 30&#37; at the 3rd visit&#46; Therefore&#44; 70&#46;6&#37; of patients reduced their iPTH levels by more than 30&#37; in 6 months&#46; The relationship between treatment success and both glomerular filtration rate and body mass index was significant&#46; There were few adverse events&#44; although hypercalcaemia was found in 5&#46;4&#37; of patients&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Treatment with paricalcitol is effective in controlling secondary hyperparathyroidism in non-dialysed patients with a wide safety margin&#46;</span></p>"
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            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Slatopolsky E, Delmez JA. Pathogenesis of secondary hyperparathyroidism. Am J Kidney Dis 1994;23:229-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8311080" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Khan S. Vitamin D deficiency and secondary hyperparathyroidism among patients with chronic kidney disease. Am J Med Sci 2007;333:201-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17435411" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Bakris GL, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of anormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:31-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17091124" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martínez I, Saracho R, Montenegro J, Llach F. A deficit of calcitriol synthesis may not be the initial factor in the pathogenesis of secondary hyperparathyroidism. Nephrol Dial Transplant 1996;11(Suppl 3):22-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8840307" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Felsenfeld AJ, Rodríguez M. Phosphorus, regulation of plasma calcium, and secondary hyperparathyroidism: a hypothesis to integrate a historical and modern perspective. J Am Soc Nephrol 1999;10:878-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10203374" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004;24:503-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15452403" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Prie D, Torres PU, Friedlander G. Latest findings in phosphate homeostasis. Kidney Int 2009;75:882-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19190675" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.\u{A0}Isakova T, Gutiérrez OM, Wolf M. A blueprint for randomized trials targeting phosphorus metabolism in chronic kidney disease. Kidney Int 2009;76:705-16. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19606082" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9.\u{A0}Friedman EA. Consequences and management of hyperphosphatemia in patients with renal insufficiency. Kidney Int 2005;(Suppl):S1-S7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Michael M, García D. Secondary hyperparathyroidism in chronic kidney disease: clinical consequences and challenges. Nephrol Nurs J 2004;31:185-94."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Malluche HH, Ritz E, Range HP. Bone histology in incipient and advanced renal failure. Kidney Int 1976;9:355-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/940274" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Coen G, Mazzaferro G, Ballanti P.\u{A0}Renal bone disease in 76 patients with varying degrees of predialysis chronic renal failure: a cross-sectional study. Nephrol Dial Transplant 1996;11:813-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671900" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Giachelli CM. The emerging role of phosphate in vascular calcification. Kidney Int 2009;75:890-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19145240" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14.\u{A0}Mittman N, Desiraju B, Meyer KB, Chattopadhyay J, Avram M. treatment of secondary hyperparathyroidism in ESDR: a 2-year, single-center crossover study. Kidney Int 2010;78(Suppl 117):S33-S36."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Moe SM, Drueke TB. Management of secondary hyperparathyroidism: the importance and the challenge of controlling parathyroid hormone levels without elevating calcium, phosphorus, and calcium-phosphorus product. Am J Nephrol 2003;23:369-79. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14551461" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Goldenberg MM. Paricalcitol, a new agent for the management of secondary hyperparathyroidism in patients undergoing chronic renal dialysis. Clin Ther 1999;21:432-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10321413" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "17.\u{A0}Cozzolino M, Brancaccio D. Emerging role for the vitamin D receptor activator (VDRA), paricalcitol, in the treatment of secondary hyperparathyroidism. Expert Opin Pharmacother 2008;9:947-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18377338" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lindberg J, Martin KJ, Gonzalez EA, Acchiardo SR, Valdin JR, Soltanek C. A long-term, multicenter study of the efficacy and safety of paricalcitol in end-stage renal disease. Clin Nephrol 2001;56:315-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11680662" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martin KJ, González EA, Gellens M, Hamm LL, Abboud H, Lindberg J. 19-Nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998;9:1427-32."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cardús A, Panizo S, Parisi E, Fernández E, Valdivielso JM. Differential effects of vitamin D analogs on vascular calcification. J Bone Miner Res 2007;22:860-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17352647" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mizobuchi M, Finch JL, Martin DR, Slatopolsky E. Differential effects of vitamin D receptor activators on vascular calcification in uremic rats. Kidney Int 2007;72:709-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17597697" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Coyne D, Acharya M, Qiu P, Abboud H, Batlle D, Rosansky S, et al. Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD. Am J Kidney Dis 2006;47:263-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16431255" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "23.\u{A0}Teng M, Wolf M, Lowrie E. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003;349:446-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12890843" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY; John Willey and Sons,1989:989."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ross EA, Tian J, Abboud H, Hippensteel R, Melnick JZ, Pradhan RS. Oral paricalcitol for the treatment of secondary hyperparathyroidism in patients on hemodialysis or peritoneal dialysis. Am J Nephrol 2008;28:97-106. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17914251" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Llach F, Yudd M. Paricalcitol in dialysis patients with calcitriol-resistant secondary hyperparathyroidism. Am J Kidney Dis 2001;38:S45-S50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11689387" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sprague SM, Llach F, Amdahl M, Taccetta C, Batlle D: Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int 2003, 63: 1483-1490. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631365" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "28.\u{A0}Segura P, Borrego\u{A0} FJ, Sánchez-Perales MC, García\u{A0} MJ, Biechy MM, Pérez V. Análisis de la eficacia y de los factores que influyen en la respuesta del hiperparatiroidismo secundario de pacientes en hemodiálisis al cinacalcet. Nefrologia 2010;30(4):443-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20651886" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(Suppl. 3):S1-S201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14520607" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Torregrosa JV, Cannata J, Bover J. Recomendaciones de la Sociedad Española de Nefrología para el manejo de las alteraciones del metabolismo óseo-mineral en los pacientes con enfermedad renal crónica. Nefrologia 2011;31(Supl 1):3-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21468161" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "31.\u{A0}Al Aly Z, González EA, Martin KJ, Gellens ME. Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle. Am J Nephrol 2004;24(4):422-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15308874" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bover J, Górriz JL, Nieto J, De Francisco ALM, Barril G, Martínez-Castelao A, et al.\u{A0}¿Hemos mejorado el controlde las alteraciones del metabolismo mineral y óseo en los últimos tres años? Análisis de los datos de los estudios OSERCE I y OSERCE II. Nefrologia 2010;30(Supl 1):46."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Peña, M, Prados D, Mañero C, López Hidalgo R, Hervás JG, Cerezo S, et al.\u{A0}Estudio multicéntrico del estado del metabolismo mineral y óseo en pacientes en hemodiálisis en Andalucía 2004-2009. Nefrologia 2010;30(Supl 1):42."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mazzaferro S, Brancaccio D, Messa P, Andeucci VE. Management of secondary hyperparathyroidism in Italy: results of the Italian FARO survey. J Nephrol 2011;24(2):225-35. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21188680" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "García Agudo R, Cazalla Cadenas F. El índice de masa corporal condiciona la dosis y respuesta de paricalcitol oral en prediálisis. Nefrologia 2010;30(Supl 1):43."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "36.\u{A0}Mathews S, Lund RJ, Chaudhary LR. Vitamin D receptors activators can protect against vascular calcification. J Am Soc Nephrol 2008;19:1509-19. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18448587" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "37.\u{A0}Fishbane S, Chittineni H, Packman M. Oral paricalcitol in the treatment of patients with CKD an proteinuria: a randomized trial. Am J Kidney Dis 2009;54:647-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19596163" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "38.\u{A0}Rojas-Rivera J, De la Piedra C, Ramos A, Ortiz A, Egido J. The expanding spectrum of biological actions of vitamin D. Nephrol Dial Transplant 2010;25:2850-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20525641" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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