From the Research
The maximum dose of Hectorol (doxercalciferol) should not exceed 18 mcg three times weekly at dialysis for patients with chronic kidney disease (CKD) on dialysis, and 3.5 mcg daily for pre-dialysis CKD patients with secondary hyperparathyroidism, as evidenced by the most recent study 1.
Key Considerations
- Dosing should be individualized based on serum intact parathyroid hormone (iPTH), calcium, and phosphorus levels.
- Regular monitoring of these parameters is essential, with dose adjustments made to maintain iPTH levels within target range while avoiding hypercalcemia.
- If serum calcium exceeds 10.5 mg/dL, Hectorol should be temporarily discontinued until calcium levels normalize.
Rationale
The use of Hectorol in patients with CKD requires careful consideration of the potential risks and benefits, including the risk of hypercalcemia and hyperphosphatemia, as noted in studies 2, 3, 4, 5. However, the most recent study 1 provides the strongest evidence for the maximum dose of Hectorol, and its findings should be prioritized in clinical decision-making.
Monitoring and Adjustments
- Serum iPTH, calcium, and phosphorus levels should be monitored regularly to ensure that Hectorol is effective and safe.
- Dose adjustments should be made as needed to maintain iPTH levels within target range while avoiding hypercalcemia and hyperphosphatemia.
- The potential risks and benefits of Hectorol should be carefully weighed in each patient, taking into account their individual needs and circumstances.