The efficacy of cinacalcet combined with conventional therapy on bone and mineral metabolism in dialysis patients with secondary hyperparathyroidism: a meta-analysis.
Cinacalcet, the first calcimimetic to be approved for the treatment of secondary hyperparathyroidism (SHPT) in the chronic kidney disease patients, offers a novel therapeutic approach to SHPT. The aim of this meta-analysis is to access the efficacy and safety of cinacalcet on bone and mineral metabolism disorders in the dialysis patients with SHPT. Randomized controlled trials on cinacalcet combined with vitamin D and/or phosphate binders in the dialysis patients with SHPT were identified in Pubmed, Sciencedirect, and the Cochrane library. Data were analyzed with RevMan software. We compared the proportion of patients achieving the biochemical targets recommended by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and the incidence of adverse events between the cinacalcet and control groups. Six trials involving 2,548 patients were included. A greater proportion of patients in the cinacalcet group compared with the conventional group achieved the KDOQI targets. The relative risks (RRs) were parathyroid hormone (PTH) (RR = 3.51, 95 % CI: 2.38-5.17), calcium (RR = 2.04, 95 % CI: 1.76-2.37), phosphorus (RR = 1.15, 95 % CI: 0.83-1.60), and calcium-phosphorus product (Ca × P) (RR = 1.41, 95 % CI: 1.18-1.69), the number of patients simultaneously achieving the KDOQI targets for PTH + Ca × P was also greater (RR = 3.89, 95 % CI: 2.36-6.41), with p < 0.001 for each. The most common adverse events were nausea, vomiting, diarrhea, and hypocalcemia, which had a higher incidence in the cinacalcet group, but were usually mild to moderate in severity and transient. Compared with conventional therapy, treatment with cinacalcet results in more patients achieving KDOQI targets and offers an effective and safety therapeutic option for controlling mineral and bone disorders in the dialysis patients with SHPT.
Department of Nephrology, The Affiliated Hospital of Qingdao University Medical College, No. 16 Jiangsu Road, The Southern Direct, Qingdao City, Shandong Province, China.
Dan
D
Li
Leping
L
Shao
Haiyan
H
Zhou
Wei
W
Jiang
Wei
W
Zhang
Yan
Y
Xu
D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D002113:Calcification, Physiologic / Q000187:drug effects*; D057966:Calcimimetic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000378:metabolism / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D000069449:Cinacalcet; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009281:Naphthalenes / Q000009:adverse effects / Q000627:therapeutic use*; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010710:Phosphates / Q000037:antagonists & inhibitors / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects*; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D057966:Calcimimetic Agents; D002136:Calcium, Dietary; D002614:Chelating Agents; D009281:Naphthalenes; D010710:Phosphates; D014807:Vitamin D; D000069449:Cinacalcet