Endocrine

, Volume 43, Issue 1, pp 68–77

The efficacy of cinacalcet combined with conventional therapy on bone and mineral metabolism in dialysis patients with secondary hyperparathyroidism: a meta-analysis

  • Dan Li
  • Leping Shao
  • Haiyan Zhou
  • Wei Jiang
  • Wei Zhang
  • Yan Xu
Meta-Analysis

DOI: 10.1007/s12020-012-9711-2

Cite this article as:
Li, D., Shao, L., Zhou, H. et al. Endocrine (2013) 43: 68. doi:10.1007/s12020-012-9711-2

Abstract

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.

Keywords

CinacalcetDialysisKDOQISecondary hyperparathyroidism

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dan Li
    • 1
  • Leping Shao
    • 1
  • Haiyan Zhou
    • 1
  • Wei Jiang
    • 1
  • Wei Zhang
    • 1
  • Yan Xu
    • 1
  1. 1.Department of NephrologyThe Affiliated Hospital of Qingdao University Medical CollegeQingdao CityChina