Meta-analysis: the efficacy and safety of paricalcitol for the treatment of secondary hyperparathyroidism and proteinuria in chronic kidney disease

Abstract

Introduction: 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.

Figure 1

Comparison of the probability of achieving ≥30% decrease in iPTH from baseline for two consecutive measures.

Figure 2

Comparison of the mean change in eGFR (mL/min/1.73 m²) from baseline to final visit.

Figure 3

Comparison of the reduction in proteinuria.

Figure 4

Comparison of the reduction in proteinuria netween the 1 ug/d and 2 ug/d groups.

Figure 5

Incidence of hypercalcemia.

Figure 6

Incidence of hyperphosphatemia.

Figure 7

Incidence of an elevation in calcium × phosphorus product.