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Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.
Int Urol Nephrol. 2016 Apr; 48(4):571-84.IU

Abstract

PURPOSE

The goal of this systematic review is to evaluate the efficacy and safety of paricalcitol versus active non-selective vitamin D receptor activators (VDRAs) for secondary hyperparathyroidism (SHPT) management in chronic kidney disease (CKD) patients.

METHODS

PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov (inception to September 2015), and ASN Web site were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs that assessed the effects and adverse events of paricalcitol and active non-selective VDRA in adult CKD patients with SHPT was performed using Review Manager 5.2.

RESULTS

A total of 10 trials involving 734 patients were identified for this review. The quality of included trials was limited, and very few trials reported all-cause mortality or cardiovascular calcification without any differences between two groups. Compared with active non-selective VDRAs, paricalcitol showed no significant difference in both PTH reduction (MD -7.78, 95% CI -28.59-13.03, P = 0.46) and the proportion of patients who achieved the target reduction of PTH (OR 1.27, 95% CI 0.87-1.85, P = 0.22). In addition, no statistical differences were found in terms of serum calcium, episodes of hypercalcemia, serum phosphorus, calcium × phosphorus products, and bone metabolism index.

CONCLUSIONS

Current evidence is insufficient, showing paricalcitol is superior to active non-selective VDRAs in lowering PTH or reducing the burden of mineral loading. Further trials are required to prove the tissue-selective effect of paricalcitol and to overcome the limitation of current research.

Authors+Show Affiliations

Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China. lizi335@hotmail.com.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26748501

Citation

Cai, Panpan, et al. "Comparison Between Paricalcitol and Active Non-selective Vitamin D Receptor Activator for Secondary Hyperparathyroidism in Chronic Kidney Disease: a Systematic Review and Meta-analysis of Randomized Controlled Trials." International Urology and Nephrology, vol. 48, no. 4, 2016, pp. 571-84.
Cai P, Tang X, Qin W, et al. Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol. 2016;48(4):571-84.
Cai, P., Tang, X., Qin, W., Ji, L., & Li, Z. (2016). Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. International Urology and Nephrology, 48(4), 571-84. https://doi.org/10.1007/s11255-015-1195-6
Cai P, et al. Comparison Between Paricalcitol and Active Non-selective Vitamin D Receptor Activator for Secondary Hyperparathyroidism in Chronic Kidney Disease: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Int Urol Nephrol. 2016;48(4):571-84. PubMed PMID: 26748501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. AU - Cai,Panpan, AU - Tang,Xiaohong, AU - Qin,Wei, AU - Ji,Ling, AU - Li,Zi, Y1 - 2016/01/09/ PY - 2015/06/25/received PY - 2015/12/19/accepted PY - 2016/1/11/entrez PY - 2016/1/11/pubmed PY - 2017/1/10/medline KW - Active vitamin D receptor activator KW - Meta-analysis KW - Non-selective KW - Paricalcitol KW - Secondary hyperparathyroidism SP - 571 EP - 84 JF - International urology and nephrology JO - Int Urol Nephrol VL - 48 IS - 4 N2 - PURPOSE: The goal of this systematic review is to evaluate the efficacy and safety of paricalcitol versus active non-selective vitamin D receptor activators (VDRAs) for secondary hyperparathyroidism (SHPT) management in chronic kidney disease (CKD) patients. METHODS: PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov (inception to September 2015), and ASN Web site were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs that assessed the effects and adverse events of paricalcitol and active non-selective VDRA in adult CKD patients with SHPT was performed using Review Manager 5.2. RESULTS: A total of 10 trials involving 734 patients were identified for this review. The quality of included trials was limited, and very few trials reported all-cause mortality or cardiovascular calcification without any differences between two groups. Compared with active non-selective VDRAs, paricalcitol showed no significant difference in both PTH reduction (MD -7.78, 95% CI -28.59-13.03, P = 0.46) and the proportion of patients who achieved the target reduction of PTH (OR 1.27, 95% CI 0.87-1.85, P = 0.22). In addition, no statistical differences were found in terms of serum calcium, episodes of hypercalcemia, serum phosphorus, calcium × phosphorus products, and bone metabolism index. CONCLUSIONS: Current evidence is insufficient, showing paricalcitol is superior to active non-selective VDRAs in lowering PTH or reducing the burden of mineral loading. Further trials are required to prove the tissue-selective effect of paricalcitol and to overcome the limitation of current research. SN - 1573-2584 UR - https://www.unboundmedicine.com/medline/citation/26748501/Comparison_between_paricalcitol_and_active_non_selective_vitamin_D_receptor_activator_for_secondary_hyperparathyroidism_in_chronic_kidney_disease:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - https://doi.org/10.1007/s11255-015-1195-6 DB - PRIME DP - Unbound Medicine ER -