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400 300 I 7⁄8 iE 200 D100 Fig. 1. Change in serum intact PTH concentration. minum accumulation, for the treatment of mild to moderate secondary HPT. Five patients whose parathyroid hormone (PTH) concentration before hemodialysis was between 200 and 400 pg/ml were selected. All patients were hemodialyzed for 5 h three times weekly, employing a dialysate calcium concentration of 3,5 mEq/1. The age of the patients was 62 ± (SE) 7 years, the duration of hemodialysis was 8.5 ± 2.3 years, the doses of lα(OH)D3 administered were 0.6 ± 0.1 μg/day, and the doses of calcium carbonate were 3.5 ± 0.5 g/day. After the levels of serum total calcium, inorganic phosphate (Pi), alkaline phosphatase (ALP) and intact PTH had been measured, the prescription was changed. 2 μg l,25-(OH)2D3 was adDear Sir, Intravenous administration of 1,25-dihy-droxyvitamin D3 [l,25-(OH)2D3; intravenous pulse therapy] has been reported to improve severe secondary hyperparathyroidism (HPT) which is refractory to conventional therapy through a transient increase in the serum l,25-(OH)2D3 concentration [1-3]. Although daily oral administration of 1,25-(OH)2D3 leads to hypercalcemia because of accompanying intestinal calcium absorption when the doses increase, it has been demonstrated that oral administration of 1,25-(OH)2D3 at high doses twice a week combined with an aluminum-containing phosphate binder (oral pulse therapy) can improve severe secondary HPT with little effect of the serum calcium concentration. [4]. However, hypercalcemia was sometimes experienced with such oral pulse therapy. In our view, even small doses of aluminum should not be prescribed to patients with chronic renal failure, since aluminum is absorbed from the intestine in chronic renal failure more than in normals [5]. Prescription of aluminum hydroxide together with vitamin D metabolites further increases the intestinal absorption of aluminum [6], the majority of the serum aluminum