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Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials.
BMC Nephrol. 2017 Aug 25; 18(1):272.BN

Abstract

BACKGROUND

Secondary hyperparathyroidism (SHPT) is a severe complication for dialysis patients. Vitamin D receptor activators (VDRAs) are used to treat SHPT, but the comparative efficacy and safety between paricalcitol and other vitamin D receptor activators for management of SHPT in dialysis patients has been unproven.

METHODS

We searched PubMed, Embase, and the Cochrane Library for the time period through June 2017 to identify randomized controlled trials that evaluated paricalcitol compared with other VDRAs for treatment of SHPT. The primary outcome was the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline. Secondary outcomes included incidences of hypercalcemia and hyperphosphatemia. The random-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).

RESULTS

Eight studies (N = 759) were eligible for final inclusion. Compared with other VDRAs, no significant differences were found in the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline for paricalcitol treatment of SHPT in dialysis patients (RR, 1.01; 95% CI, 0. 87-1.18; p = 0.85). There were no differences in the incidence of hypercalcemia (RR, 0.95; 95% CI, 0.74-1.21; p = 0. 65) and hyperphosphatemia (RR, 0.94; 95% CI, 0.77-1.16; p = 0.58).

CONCLUSIONS

The presently available evidence is insufficient to draw a conclusion regarding whether paricalcitol therapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT. Large-sample, well-conducted, high-quality RCTs with patient-level outcomes (i.e., mortality) are urgently needed.

Authors+Show Affiliations

Department of Nephrology, The Third Affiliated Hospital of Guangxi University of Chinese medicine, No.32, Jie-Fang-Bei Road, Cheng-Zhong District, Liuzhou, Guangxi, 545001, People's Republic of China. xieyifeng1983@163.com.Department of Nephrology, The Third Affiliated Hospital of Guangxi University of Chinese medicine, No.32, Jie-Fang-Bei Road, Cheng-Zhong District, Liuzhou, Guangxi, 545001, People's Republic of China.Department of Clinical Laboratory, The Third Affiliated Hospital of Guangxi University of Chinese medicine, Liuzhou, Guangxi, People's Republic of China.Department of Orthopaedics, The Third Affiliated Hospital of Guangxi University of Chinese medicine, Liuzhou, Guangxi, People's Republic of China.Department of Nephrology, The Third Affiliated Hospital of Guangxi University of Chinese medicine, No.32, Jie-Fang-Bei Road, Cheng-Zhong District, Liuzhou, Guangxi, 545001, People's Republic of China.Department of Nephrology, The Third Affiliated Hospital of Guangxi University of Chinese medicine, No.32, Jie-Fang-Bei Road, Cheng-Zhong District, Liuzhou, Guangxi, 545001, People's Republic of China.Department of Nephrology, The Third Affiliated Hospital of Guangxi University of Chinese medicine, No.32, Jie-Fang-Bei Road, Cheng-Zhong District, Liuzhou, Guangxi, 545001, People's Republic of China.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

28841848

Citation

Xie, Yifeng, et al. "Comparative Efficacy and Safety of Paricalcitol Versus Vitamin D Receptor Activators for Dialysis Patients With Secondary Hyperparathyroidism: a Meta-analysis of Randomized Controlled Trials." BMC Nephrology, vol. 18, no. 1, 2017, p. 272.
Xie Y, Su P, Sun Y, et al. Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials. BMC Nephrol. 2017;18(1):272.
Xie, Y., Su, P., Sun, Y., Zhang, H., Zhao, R., Li, L., & Meng, L. (2017). Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials. BMC Nephrology, 18(1), 272. https://doi.org/10.1186/s12882-017-0691-6
Xie Y, et al. Comparative Efficacy and Safety of Paricalcitol Versus Vitamin D Receptor Activators for Dialysis Patients With Secondary Hyperparathyroidism: a Meta-analysis of Randomized Controlled Trials. BMC Nephrol. 2017 Aug 25;18(1):272. PubMed PMID: 28841848.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials. AU - Xie,Yifeng, AU - Su,Peiling, AU - Sun,Yifan, AU - Zhang,Hongsheng, AU - Zhao,Rong, AU - Li,Liang, AU - Meng,Lanfen, Y1 - 2017/08/25/ PY - 2016/05/04/received PY - 2017/08/18/accepted PY - 2017/8/27/entrez PY - 2017/8/27/pubmed PY - 2018/5/10/medline KW - Hemodialysis KW - Paricalcitol KW - Peritoneal dialysis KW - Secondary hyperparathyroidism (SHPT) KW - Vitamin D receptor activator SP - 272 EP - 272 JF - BMC nephrology JO - BMC Nephrol VL - 18 IS - 1 N2 - BACKGROUND: Secondary hyperparathyroidism (SHPT) is a severe complication for dialysis patients. Vitamin D receptor activators (VDRAs) are used to treat SHPT, but the comparative efficacy and safety between paricalcitol and other vitamin D receptor activators for management of SHPT in dialysis patients has been unproven. METHODS: We searched PubMed, Embase, and the Cochrane Library for the time period through June 2017 to identify randomized controlled trials that evaluated paricalcitol compared with other VDRAs for treatment of SHPT. The primary outcome was the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline. Secondary outcomes included incidences of hypercalcemia and hyperphosphatemia. The random-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Eight studies (N = 759) were eligible for final inclusion. Compared with other VDRAs, no significant differences were found in the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline for paricalcitol treatment of SHPT in dialysis patients (RR, 1.01; 95% CI, 0. 87-1.18; p = 0.85). There were no differences in the incidence of hypercalcemia (RR, 0.95; 95% CI, 0.74-1.21; p = 0. 65) and hyperphosphatemia (RR, 0.94; 95% CI, 0.77-1.16; p = 0.58). CONCLUSIONS: The presently available evidence is insufficient to draw a conclusion regarding whether paricalcitol therapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT. Large-sample, well-conducted, high-quality RCTs with patient-level outcomes (i.e., mortality) are urgently needed. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/28841848/Comparative_efficacy_and_safety_of_paricalcitol_versus_vitamin_D_receptor_activators_for_dialysis_patients_with_secondary_hyperparathyroidism:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://www.biomedcentral.com/1471-2369/18/272 DB - PRIME DP - Unbound Medicine ER -