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When and How Should Calcitriol Be Used in Dialysis Patients?

Calcitriol has been used since the early 1970s for the treatment of secondary hyperparathyroidism both in adults and in pediatric patients undergoing regular dialysis; it is also commonly given to facilitate growth and skeletal development in children with advanced renal failure (1). Despite such widespread clinical use, recommendations about when and how calcitriol should be given to patients with end-stage renal disease vary considerably, and the objectives of treatment have often not been presented in sufficient detail to be of practical value for nephrologists. Moreover, several recent developments, such as the changing spectrum of renal bone disease, have potentially important implications for the proper long-term use of calcitriol in those undergoing regular dialysis. The purpose of the current review is to address the impact of these newer observations on the overall management of renal osteodystrophy in children and adults, with particular reference to specific therapeutic outcomes in patients with different types of renal bone disease.