Efficacy and safety of paricalcitol therapy for chronic kidney disease: a meta-analysis.
OBJECTIVE
Observational data indicate that newer vitamin D compounds such as paricalcitol can suppress serum intact parathyroid hormone (iPTH) and reduce proteinuria in patients with CKD. To systematically evaluate the efficacy and safety of paricalcitol for CKD, we conducted a meta-analysis of the published randomized controlled trials (RCTs).


METHODS
MEDLINE, Embase, the Cochrane Library, and article reference lists were searched for RCTs that compared paricalcitol with placebo in the treatment of patients with stage 2-5 CKD. The quality of the studies was evaluated using the Jadad method. The results are summarized as risk ratios (RRs) for dichotomous outcomes or mean differences for continuous outcomes.


RESULTS
Nine studies (832 patients) were included. Compared with placebo, paricalcitol suppressed serum iPTH (RR, 6.37; 95% confidence interval [95% CI], 4.64-8.74; P<0.001) and reduced proteinuria (RR, 1.68; 95% CI, 1.25-2.25; P<0.001). Compared with the control group, the RR for hypercalcemia associated with paricalcitol use was 2.25 (95% CI, 0.81-6.26; P=0.12). Patients receiving paricalcitol therapy did not have an increased risk of endocrine system and cardiovascular system adverse effects (RR, 1.07; 95% CI, 0.84-1.36; P=0.58).


CONCLUSIONS
We conﬁrm that paricalcitol suppresses iPTH and lowers proteinuria in patients with stage 2-5 CKD without an increased risk of adverse events. A trend toward increased hypercalcemia did not reach statistical signiﬁcance, but may be clinically relevant. A randomized trial is needed to determine if paricalcitol affects the development of ESRD or mortality.
Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China.
Jun
J
Cheng
Wen
W
Zhang
Xiaohui
X
Zhang
Xiayu
X
Li
Jianghua
J
Chen
D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004872:Ergocalciferols / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood; D011507:Proteinuria / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D004872:Ergocalciferols; C470125:PTH protein, human; D010281:Parathyroid Hormone; C084656:paricalcitol