The goal of this systematic review is to evaluate the efficacy and safety of paricalcitol versus active non-selective vitamin D receptor activators (VDRAs) for secondary hyperparathyroidism (SHPT) management in chronic kidney disease (CKD) patients.
PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov (inception to September 2015), and ASN Web site were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs that assessed the effects and adverse events of paricalcitol and active non-selective VDRA in adult CKD patients with SHPT was performed using Review Manager 5.2.
A total of 10 trials involving 734 patients were identified for this review. The quality of included trials was limited, and very few trials reported all-cause mortality or cardiovascular calcification without any differences between two groups. Compared with active non-selective VDRAs, paricalcitol showed no significant difference in both PTH reduction (MD −7.78, 95 % CI −28.59–13.03, P = 0.46) and the proportion of patients who achieved the target reduction of PTH (OR 1.27, 95 % CI 0.87–1.85, P = 0.22). In addition, no statistical differences were found in terms of serum calcium, episodes of hypercalcemia, serum phosphorus, calcium × phosphorus products, and bone metabolism index.
Current evidence is insufficient, showing paricalcitol is superior to active non-selective VDRAs in lowering PTH or reducing the burden of mineral loading. Further trials are required to prove the tissue-selective effect of paricalcitol and to overcome the limitation of current research.
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The authors would like to acknowledge Professor Guanjian Liu in Evidence-Based Medicine Center of China for his assistance in the design, literature searching, analysis, and interpretation of this study.
TXH contributed to the concept, design, data collection, analysis, interpretation, and manuscript preparation of this study. CPP contributed to the concept, data collection, interpretation and manuscript preparation of this study. JL contributed to the concept, data collection and analysis of this study. QW contributed to the concept, design, analysis and interpretation of this study. LZ contributed to the concept, design, data collection, analysis, interpretation, and manuscript preparation of this study. All authors have read and approved the final manuscript.
Conflict of interest
The authors declare that there are no conflicts of interest.
Panpan Cai and Xiaohong Tang have contributed equally to this work.
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Cai, P., Tang, X., Qin, W. et al. Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol 48, 571–584 (2016). https://doi.org/10.1007/s11255-015-1195-6