Efficacy of Paricalcitol in the Management of CKD-MBD in Patients on Intermittent In-Center Hemodialysis: A 52-Week Follow-Up Study

Background: CKD-MBD is highly prevalent in end-stage kidney disease (ESKD) patients undergoing intermittent in-center hemodialysis (ICHD), contributing to adverse clinical outcomes. Effective management improves dialysis-associated complications, including erythropoietin (EPO) resistance, and long-term outcomes such as reduced cardiovascular risk. Paricalcitol, a selective vitamin D receptor activator (VDRA), offers potential therapeutic advantages, though its impact in loco-regional populations remains underexplored. This study evaluates Paricalcitol’s efficacy in CKD-MBD management over 52 weeks. Methods: A retrospective cohort analysis was conducted at King Faisal Specialist Hospital & Research Centre, Jeddah, screening 103 adult ICHD patients for CKD-MBD. Patients undergoing hemodialysis for ≥6 months, with good adherence to dialysis sessions and pharmacotherapy, were included. Exclusion criteria encompassed vascular access dysfunction and nonadherence. Patients prescribed Paricalcitol were assessed for changes in intact parathyroid hormone (iPTH), calcium-phosphorus product (Ca×P), pill burden, and EPO responsiveness over 52 weeks. Results: Among the 103 screened patients, 77 (74.8%) exhibited CKD-MBD, and 33 (42.8%) received Paricalcitol therapy for 52 weeks. The mean Paricalcitol dose required to achieve optimal iPTH suppression was 6.07 ± 3.1 µg post-HD (thrice weekly). After 52 weeks, we observed a 58% mean reduction in iPTH from baseline (p < 0.01; 95% CI: 48%–68%). Paricalcitol significantly reduced CKD-MBD pill burden by 4.2 ± 3.1 tablets/day (p < 0.05), with Sevelamer showing the greatest decrease (45% from baseline). Hemoglobin levels improved by 0.8–1.7 g/L (p = 0.03) without EPO dose modification, suggesting enhanced EPO responsiveness, potentially linked to reduced inflammation and VDRA-mediated erythropoiesis modulation. No significant adverse effects were reported over the study duration. Conclusion: Paricalcitol demonstrated efficacy in achieving target CKD-MBD goals, reducing pill burden, and improving EPO responsiveness in ICHD patients over 52 weeks. These findings underscore the need for large-scale prospective trials to validate its long-term benefits and optimize CKD-MBD management strategies in dialysis-dependent populations.