title: Effect of Vitamin D Receptor Activators on Glomerular Filtration Rate: A Meta-Analysis and Systematic Review.
abstract: BACKGROUND
  Vitamin D receptor activators (VDRAs) can protect against mineral bone disease, but they are reported to elevate serum creatinine (SCr) and may also reduce glomerular filtration rate (GFR).
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to evaluate the effect of VDRAs on kidney function and adverse events. MEDLINE, EMBASE, the Cochrane Controlled Trials Register were searched for RCTs that evaluate vitamin D receptor activators (alfacalcidol, calcitriol, doxercalciferol, falecalcitriol, maxacalcitol and paricalcitol) up to March 2015.
  
  
  RESULTS
  We included 31 studies, all of which were performed between 1976 and 2015, which enrolled 2621 patients. Patients receiving VDRAs had lower eGFR (weighted mean difference WMD -1.29 mL/min /1.73 m2, 95% CI -2.42 to -0.17) and elevated serum creatinine (WMD 7.03 μmol/L, 95% CI 0.61 to 13.46) in sensitivity analysis excluding studies with dropout rate more than 30%. Subgroup analysis of the 5 studies that not use SCr-based measures did not indicated lower GFR in the VDRAs group(WMD -0.97 mL/min/1.73 m2, 95% CI -4.85 to 2.92). Compared with control groups, there was no difference in all-cause mortality (relative risk RR 1.41, 95% CI 0.58 to 3.80), cardiovascular disease (RR 0.84, 95% CI 0.42 to 1.71), and severe adverse events (RR 1.15, 95% CI 0.75 to 1.77) for the VDRAs groups. Episodes of hypercalcemia (RR 3.29, 95% CI 2.02 to 5.38) were more common in the VDRAs group than in the control group.
  
  
  CONCLUSIONS
  Administration of VDRAs increased serum creatinine levels. Subgroup analysis of studies that did not use SCr-based measures did not indicate a lower GFR in the VDRA group. Future studies with non-SCr-based measures are needed to assess whether the mild elevations of serum creatinine are of clinical significance.
authors.affiliation: Division of Nephrology, Huashan Hospital and Huashan Hospital North, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of TCM, Jing'an District centre hospital of Shanghai, Shanghai, China.
authors.forename: Tiansong
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001847:Bone Diseases / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D005919:Glomerular Filtration Rate; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D018167:Receptors, Calcitriol / Q000819:agonists* / Q000378:metabolism
chemical_list: D050071:Bone Density Conservation Agents; D018167:Receptors, Calcitriol; D003404:Creatinine
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