Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis
Yang Liu,1 Ling-Yun Liu,2 Ye Jia,1 Mei-Yan Wu,1 Yan-Yan Sun,3 Fu-Zhe Ma1 1Department of Nephrology, The First Hospital of Jilin University, Changchun, China; 2Department of Andrology, The First Hospital of Jilin University, Changchun, China; 3Department of Nephrology, The Fourth Hospital of Jilin U...
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| Format: | Article |
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Dove Medical Press
2019-03-01
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| Series: | Drug Design, Development and Therapy |
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| Online Access: | https://www.dovepress.com/efficacy-and-safety-of-paricalcitol-in-patients-undergoing-hemodialysi-peer-reviewed-article-DDDT |
| _version_ | 1819012485610471424 |
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| author | Liu Y Liu LY Jia Y Wu MY Sun YY Ma FZ |
| author_facet | Liu Y Liu LY Jia Y Wu MY Sun YY Ma FZ |
| author_sort | Liu Y |
| collection | DOAJ |
| description | Yang Liu,1 Ling-Yun Liu,2 Ye Jia,1 Mei-Yan Wu,1 Yan-Yan Sun,3 Fu-Zhe Ma1 1Department of Nephrology, The First Hospital of Jilin University, Changchun, China; 2Department of Andrology, The First Hospital of Jilin University, Changchun, China; 3Department of Nephrology, The Fourth Hospital of Jilin University, Changchun, China Background: The elevated calcium and phosphorus levels in patients undergoing hemodialysis may increase the risk of all-cause mortality. Paricalcitol, as a new vitamin D receptor activator (VDRA), seemed to be effective in reducing the calcium and phosphorus levels.Objectives: The aim of this study was to compare the efficacy and safety of paricalcitol with other VDRAs in patients undergoing hemodialysis.Methods: PubMed, Embase, and Web of Science database were systematically reviewed.Selection criteria: Studies that focused on the use of paricalcitol for hemodialysis patients were eligible for inclusion.Data collection and analysis: Two independent investigators performed the literature search, data extraction, and assessment of methodological quality. The outcomes were expressed with standard mean difference (SMD), HR, or risk ratio (RR) with 95% CI.Results: Thirteen studies involving 112,695 patients were included in this meta-analysis. Among these studies, four studies were cohort studies and nine studies were randomized controlled trials (RCTs). For cohort studies, they were regarded as being of high quality; for RCTs, only one was classified as being at low risk of bias; and the remaining eight studies were at being unclear risk of bias. Compared with other VDRAs, paricalcitol significantly improved the overall survival (HR =0.86, 95% CI: 0.80, 0.92; P<0.001) and reduced the intact parathyroid hormone (iPTH) (SMD =-0.53, 95% CI: -0.90, -0.17; P=0.004). Paricalcitol offered similar effect with other VDRAs in the control of calcium (SMD =0.32, 95% CI: -0.04, 0.67; P=0.078) and phosphorus (SMD =0.06, 95% CI: -0.26, 0.37; P=0.727) levels. However, the serum change in calcium phosphate product was greater in the paricalcitol group than in the other VDRA group (SMD =2.13, 95% CI: 0.19, 4.07; P=0.031). There was no significant difference in the incidence of adverse events between the two groups (RR =1.02, 95% CI: 0.93, 1.12; P=0.674).Conclusion: Paricalcitol was crucial in reducing the mortality in patients undergoing hemodialysis. Moreover, both paricalcitol and other VDRAs were effective in control of the serum iPTH, calcium, and phosphorus levels. Given the potential limitations in this study, more prospective large-scale, well-conducted RCTs are needed to confirm these findings. Keywords: hemodialysis, paricalcitol, vitamin D receptor activator, meta-analysis |
| first_indexed | 2024-12-21T01:44:48Z |
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| id | doaj.art-dd49f29c1c7e4d649964ede08eafcbed |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-12-21T01:44:48Z |
| publishDate | 2019-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Drug Design, Development and Therapy |
| spelling | doaj.art-dd49f29c1c7e4d649964ede08eafcbed2022-12-21T19:20:04ZengDove Medical PressDrug Design, Development and Therapy1177-88812019-03-01Volume 13999100944812Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysisLiu YLiu LYJia YWu MYSun YYMa FZYang Liu,1 Ling-Yun Liu,2 Ye Jia,1 Mei-Yan Wu,1 Yan-Yan Sun,3 Fu-Zhe Ma1 1Department of Nephrology, The First Hospital of Jilin University, Changchun, China; 2Department of Andrology, The First Hospital of Jilin University, Changchun, China; 3Department of Nephrology, The Fourth Hospital of Jilin University, Changchun, China Background: The elevated calcium and phosphorus levels in patients undergoing hemodialysis may increase the risk of all-cause mortality. Paricalcitol, as a new vitamin D receptor activator (VDRA), seemed to be effective in reducing the calcium and phosphorus levels.Objectives: The aim of this study was to compare the efficacy and safety of paricalcitol with other VDRAs in patients undergoing hemodialysis.Methods: PubMed, Embase, and Web of Science database were systematically reviewed.Selection criteria: Studies that focused on the use of paricalcitol for hemodialysis patients were eligible for inclusion.Data collection and analysis: Two independent investigators performed the literature search, data extraction, and assessment of methodological quality. The outcomes were expressed with standard mean difference (SMD), HR, or risk ratio (RR) with 95% CI.Results: Thirteen studies involving 112,695 patients were included in this meta-analysis. Among these studies, four studies were cohort studies and nine studies were randomized controlled trials (RCTs). For cohort studies, they were regarded as being of high quality; for RCTs, only one was classified as being at low risk of bias; and the remaining eight studies were at being unclear risk of bias. Compared with other VDRAs, paricalcitol significantly improved the overall survival (HR =0.86, 95% CI: 0.80, 0.92; P<0.001) and reduced the intact parathyroid hormone (iPTH) (SMD =-0.53, 95% CI: -0.90, -0.17; P=0.004). Paricalcitol offered similar effect with other VDRAs in the control of calcium (SMD =0.32, 95% CI: -0.04, 0.67; P=0.078) and phosphorus (SMD =0.06, 95% CI: -0.26, 0.37; P=0.727) levels. However, the serum change in calcium phosphate product was greater in the paricalcitol group than in the other VDRA group (SMD =2.13, 95% CI: 0.19, 4.07; P=0.031). There was no significant difference in the incidence of adverse events between the two groups (RR =1.02, 95% CI: 0.93, 1.12; P=0.674).Conclusion: Paricalcitol was crucial in reducing the mortality in patients undergoing hemodialysis. Moreover, both paricalcitol and other VDRAs were effective in control of the serum iPTH, calcium, and phosphorus levels. Given the potential limitations in this study, more prospective large-scale, well-conducted RCTs are needed to confirm these findings. Keywords: hemodialysis, paricalcitol, vitamin D receptor activator, meta-analysishttps://www.dovepress.com/efficacy-and-safety-of-paricalcitol-in-patients-undergoing-hemodialysi-peer-reviewed-article-DDDTHemodialysisparicalcitolvitamin D receptor activatormeta-analysis |
| spellingShingle | Liu Y Liu LY Jia Y Wu MY Sun YY Ma FZ Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis Drug Design, Development and Therapy Hemodialysis paricalcitol vitamin D receptor activator meta-analysis |
| title | Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis |
| title_full | Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis |
| title_fullStr | Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis |
| title_full_unstemmed | Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis |
| title_short | Efficacy and safety of paricalcitol in patients undergoing hemodialysis: a meta-analysis |
| title_sort | efficacy and safety of paricalcitol in patients undergoing hemodialysis a meta analysis |
| topic | Hemodialysis paricalcitol vitamin D receptor activator meta-analysis |
| url | https://www.dovepress.com/efficacy-and-safety-of-paricalcitol-in-patients-undergoing-hemodialysi-peer-reviewed-article-DDDT |
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