Comparison of intermittent intravenous and oral calcitriol in the treatment of secondary hyperparathyroidism in chronic hemodialysis patients: a meta-analysis of randomized controlled trials.
BACKGROUND
Controversy exists regarding the optimal route and mode of calcitriol administration in the treatment of secondary hyperparathyroidism (SHPT). The aim of this study is to compare the efficacy and adverse reaction of calcitriol in the same mode (intermittent) but different route (intravenous versus oral) in the treatment of SHPT.


METHODS
Electronic databases including Medline, Embase, Cochrane-controlled trials register, China Biological Medicine Disk (updated February 2008), and manual bibliographical searches were conducted. A meta-analysis of all randomized controlled trials (RCTs) comparing intermittent intravenous with intermittent oral calcitriol in the treatment of SHPT was performed.


RESULTS
6 studies from 5 countries were finally considered for the meta-analysis, including a multicenter trial. The results of meta-analyses showed that there were no significant differences between the two routes in suppressing iPTH, AKP and rising Ca, P. In sensitivity analyses (baseline iPTH > or = 600 pg/ml, baseline iPTH < 600 pg/ml, and excluding the multicenter trial), the results were similar to those of the overall analyses. Results of the descriptive analysis showed that there were no significant differences between the two routes in the incidence of hypercalcemia and hyperphosphatemia.


CONCLUSIONS
Our analysis indicated that there were no significant differences between intermittent intravenous and oral calcitriol in the treatment of SHPT, both in their efficacy and adverse reaction. Since the present studies had several limitations in methodological design and sample size, largescale and long-term comparisons of intermittent intravenous and oral treatment need to be done in a randomized, double-blind, placebo-controlled design to accurately evaluate their relative efficacy and safety.
Haiyang Zhou
Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Chenggang Xu
D000284:Administration, Oral; D002117:Calcitriol / Q000008:administration & dosage*; D016001:Confidence Intervals; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000209:etiology*; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D014815:Vitamins / Q000008:administration & dosage*
D014815:Vitamins; D002117:Calcitriol