The effect of local injections of paricalcitol into the parathyroid glands on parathyroid hormone levels, vascular calcification, and bone mineral density in patients with chronic kidney disease

Aim. To study the effects of local paricalcitol injections into the parathyroid glands on bone turnover in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) with moderately elevated parathyroid hormone (PTH) levels (300–600 pg/mL).

Materials and methods. The study included 48 patients with end-stage CKD and SHPT with PTH levels of 300–600 pg/mL. All patients received standard medical therapy before the study, including correction of hyperphosphatemia, hypocalcemia, and disorders of calcium-phosphorus metabolism. The main group (n = 14) comprised patients for whom ultrasound-guided paricalcitol injections into the parathyroid glands were technically feasible. The dynamics of PTH levels, vascular calcification, bone mineral density (BMD), and levels of PTH, b-CrossLaps, and FGF23 were assessed.

Results. Multivariate logistic regression analysis demonstrated that osteoporosis and vascular calcification were significantly associated with age, PTH levels, dialysis duration, comorbidity index, b-CrossLaps, and FGF23. Threshold values for age and PTH were 33 years and 301 pg/mL for the development of osteoporosis and 29 years and 301 pg/mL for vascular calcification. Correlation analysis revealed a statistically significant relationship between FGF23 and dialysis duration, b-CrossLaps and PTH levels, as well as between FGF23 and b-CrossLaps. The comorbidity index also increased with age and PTH levels. After 3 and 6 months of treatment, PTH levels significantly decreased, while the volume of the parathyroid glands remained unchanged. No serious complications were observed after the injections, and transient local pain was reported in only 8 (57%) patients.

Conclusion. Ultrasound-guided paricalcitol injections into the parathyroid glands contribute to reducing PTH levels, improving bone remodeling parameters, and creating conditions for preventing cardiovascular complications. These findings require further investigation in larger-scale studies.

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