Meta-Analysis: The Efficacy and Safety of Paricalcitol for the Treatment of Secondary Hyperparathyroidism and Proteinuria in Chronic Kidney Disease

• Published in: BioMed research international 2013-01, Vol.2013 (2013), p.1-11
• Main Authors: Lv, Yongman, Stern, Leonard, Cheng, Gong, Liu, Manli, She, Ninglan, Liang, Zhu, Shu, Ying, Quan, Dayong, Rong, Gong, Han, Tianzhao, Yang, Bing
• Format: Article
• Language: English
• Subjects: Bone Density Conservation Agents - therapeutic use; Calcification (ectopic); Care and treatment; Chronic kidney failure; Complications and side effects; Dosage and administration; Drug therapy; Ergocalciferols - adverse effects; Ergocalciferols - therapeutic use; Glomerular Filtration Rate; Humans; Hypercalcemia - chemically induced; Hyperparathyroidism; Hyperparathyroidism, Secondary - drug therapy; Hyperphosphatemia - chemically induced; Kidney Failure, Chronic - drug therapy; Paricalcitol; Patient outcomes; Proteinuria; Proteinuria - drug therapy; Randomized Controlled Trials as Topic; Risk; Treatment Outcome; Vitamin D - analogs & derivatives
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2013/320560

Previous studies have demonstrated the safety and efficacy of using Paricalcitol for the treatment of secondary hyperparathyroidism (SHPT) in patients on dialysis. The aim of the current meta-analysis was to assess the safety and efficacy of Paricalcitol for the management of SHPT in patients with chronic kidney disease (CKD) not yet on dialysis. A secondary aim was to determine if sufficient data was available to assess the effect of Paricalcitol for the management of proteinuria. Methods. A meta-analysis was conducted using the Cochrane Collaboration’s RevMan 4.2 software. Results. Paricalcitol is effective in lowering PTH in patients with CKD not yet on dialysis and is also effective in lowering proteinuria in diabetic CKD patients. However, we uncovered a safety signal identifying an elevated calcium phosphate product and a trend towards the development of hypercalcemia. A phosphate elevation was not demonstrated because the target used in the clinical studies was a P>5.5 mg/dl, a value appropriate for dialysis patients and not CKD patients. Conclusion. Although Paricalcitol is effective in lowering PTH, we advise caution in the use of any active Vitamin D analogues in patients with CKD because of the potential risk of exacerbating vascular calcification.