Murt A. Comparison of parathormone lowering effects of paricalcitol and calcitriol in hemodialysis patients. World J Nephrol 2025; 14(4): 110817 [DOI: 10.5527/wjn.v14.i4.110817]
Corresponding Author of This Article
Ahmet Murt, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, No. 53 Kocamustafapaşa Caddesi, Istanbul 34000, Türkiye. ahmet.murt@istanbul.edu.tr
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Urology & Nephrology
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Prospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 25, 2025 (publication date) through Dec 23, 2025
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World Journal of Nephrology
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2220-6124
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Murt A. Comparison of parathormone lowering effects of paricalcitol and calcitriol in hemodialysis patients. World J Nephrol 2025; 14(4): 110817 [DOI: 10.5527/wjn.v14.i4.110817]
World J Nephrol. Dec 25, 2025; 14(4): 110817 Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.110817
Comparison of parathormone lowering effects of paricalcitol and calcitriol in hemodialysis patients
Ahmet Murt
Ahmet Murt, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34000, Türkiye
Author contributions: Murt A was responsible for the overall conception, design, and execution of the study, including data collection and analysis, literature review, and manuscript preparation.
Institutional review board statement: The study was approved by the Institutional Review Board of Provincial Health Directorate (Approval No. 2020-11-30T14_57_30).
Informed consent statement: All patients signed written informed consent forms and the study was performed according to the rules of Declaration of Helsinki.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement:
The data of this study is available from the corresponding author upon a reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmet Murt, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, No. 53 Kocamustafapaşa Caddesi, Istanbul 34000, Türkiye. ahmet.murt@istanbul.edu.tr
Received: June 16, 2025 Revised: July 20, 2025 Accepted: October 28, 2025 Published online: December 25, 2025 Processing time: 190 Days and 14.6 Hours
Abstract
BACKGROUND
Parathyroid hormone (PTH) levels may fluctuate in patients undergoing hemodialysis because of changes in calcium, phosphorus, and vitamin D levels. For these patients, the “Kidney Disease: Improving Global Outcomes” clinical practice guidelines recommend PTH levels be maintained in the range of two to nine times of the upper normal limit. Maintaining this balance is critical to prevent renal osteodystrophy. When the severity of hyperparathyroidism exceeds the recommended limits, vitamin D receptor agonists may be used for lowering PTH levels. Paricalcitol, as a biologically active vitamin D analog, is a selective activator of vitamin D responsive pathways. Both calcitriol and paricalcitol can be used as PTH-lowering agents. There is conflicting data about their comparative effectiveness for controlling hyperparathyroidism in patients undergoing hemodialysis and a meta-analysis revealed no differences between the two.
AIM
To give real world data comparing paricalcitol and calcitriol as PTH-lowering agents in patients undergoing hemodialysis.
METHODS
Patients undergoing hemodialysis whose PTH levels exceeded nine times of the upper normal limit were enrolled in the study. Depending on patient preferences, they were either given calcitriol or paricalcitol. Intravenous calcitriol was given 2 μg at the end of each dialysis sessions, and intravenous paricalcitol was administered as 5 μg twice per week. Demographic data, calcium-phosphorus levels, change in PTH levels in 6 months, and ratios of 25% and 50% reductions in PTH levels were compared between the two groups.
RESULTS
A total of 21 patients were enrolled in this comparative study, eight patients received paricalcitol and 13 were prescribed calcitriol. A 50% reduction in PTH levels could be achieved in five patients in the paricalcitol group (62.5%); only one patient in the calcitriol group achieved the same reduction (7.6%). The difference was statistically significant (P = 0.014). However, there was no difference in the ratio of patients who had a 25% reduction in PTH levels (87.5% vs 38.4%; P = 0.067). PTH levels could be maintained in the targeted range in 87.5% of the patients in the paricalcitol group and in 69.2% of the patients in the calcitriol group (P = 0.36). However, PTH could be better suppressed under paricalcitol. Clinically important hyperphosphatemia or hypercalcemia was not observed in either the paricalcitol or the calcitriol groups.
CONCLUSION
Although the PTH lowering effect of paricalcitol is stronger than calcitriol, both may help maintain PTH levels in the targeted range. Paricalcitol may be preferred for patients who have very high levels of PTH because it seems to cause a faster decline. Calcitriol may be preferred for a slower and limited decline. Prospective further studies with larger samples may be needed for a better comparison.
Core Tip: Parathormone control has utmost importance for patients undergoing hemodialysis to decrease fracture risk and provide better survival. Although international guidelines recommend keeping parathormone levels between two to nine times of the upper normal limit, new studies provide survival evidence for tighter control. Paricalcitol was found more effective than calcitriol in providing a faster and greater reduction of parathormone. Close monitoring of phosphorus and calcium levels avoided unintended hyperphosphatemia or hypercalcemia with either treatment.
