Recently a survey of the owners and veterinarians of nearly 2000 pets in chronic renal failure has been formulated. These animals all received calcitriol. Approximately 80% of the owners reported that their pets were brighter and more social and had better appetites on calictriol. It was also felt that these animals had a substantially longer life span than patients not receiving calcitriol. If calcitriol elevates serum calcium levels, this can lead to calcium precipitation in the kidneys making kidney damage worse. Calcitriol cannot be given to patients with elevated serum calcium levels and monitoring is necessary to make sure serum calcium levels do not rise. Similarly, calcitriol cannot be given to patients where phosphorus is too high. Phosphate binders are common in the treatment of kidney disease. If the binder in use contains calcium elevated blood calcium levels could become a concern. If calcitriol is used with a magnesium containing phosphate binder, magnesium levels can get too high.

Calcitriol is mostly used in the treatment of chronic kidney failure though it can also be used in hypocalcemia (low blood calcium). The relationship between calcitriol (active Vitamin D) and parathyroid hormone is somewhat complicated but it is not possible to understand the function of this medication without some understanding of the system. Calcitriol goes by several names: Active Vitamin D3, 1,25 dihydroxycholecalciferol, & 1,25(OH)2D3. It is probably easiest to just call it 'calictriol,' the 'trio' referring to the 3 hydroxyl groups that define it. The biochemistry of vitamin D is very different from that of other vitamins because vitamin D is actually a hormone. To understand how calcitriol is helpful therapeutically, it is necessary to understand some background information about vitamin D, its metabolic opposite parathyroid hormone, and the general calcium and phosphorus balance within the body. The story of vitamin D begins when a vitamin D precursor is eaten. The precursor we get from plants is called ergosterol and the precursor we get from eating animal tissues is called cholecalciferol. These substances are absorbed into the body for eventual activation.

 

Calcidiol is not yet fully activated until it goes to the kidney for final processing (addition of the third hydroxyl group) to make calcitriol, the full-fledged hormone ready to go to work in calcium regulation. Blood calcium levels are tightly regulated by calcitriol and parathyroid hormone. There are four tiny parathyroid glands around the thyroid gland in the throat area. These glands produce a biochemical called parathyroid hormone often abbreviated PTH. When blood calcium drops, parathyroid hormone is secreted heavily. PTH performs several actions to help bring the blood calcium level back up: Calcitriol shuts off PTH secretion. In this system, calcitriol not only assists in solving the low calcium problem, it also shuts the system down when the problem has been solved. It should be noted that calcitriol is present in one's system all the time, not only when calcium is low. During times of low calcium, though, calcitriol levels are elevated. These hormones work together to maintain the blood calcium level in a very specific range. When the kidney is diseased, it becomes unable to remove/excrete phosphorus from the bloodstream and blood phosphorus levels begin to rise. Phosphorus does two bad things at this point: it directly stimulates PTH secretion and it inhibits the enzyme needed to convert calcidiol into calcitriol. This means there is tons of PTH mobilizing calcium from the bones, leaving them soft and easily broken. The calcium mobilized from the bone promptly combines with the extra phosphorus in the blood to form calcium phosphate crystals all over the body.