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Meta-Analysis
. 2019 Jun 11;20(1):213.
doi: 10.1186/s12882-019-1388-9.

Long-term effects on PTH and mineral metabolism of 1.25 versus 1.75 mmol/L dialysate calcium in peritoneal dialysis patients: a meta-analysis

Affiliations
Meta-Analysis

Long-term effects on PTH and mineral metabolism of 1.25 versus 1.75 mmol/L dialysate calcium in peritoneal dialysis patients: a meta-analysis

Liqin Jin et al. BMC Nephrol. .

Abstract

Background: This study aimed to compare 1.25 and 1.75 mmol/L dialysate calcium for their effects on parathyroid hormone (PTH) and mineral metabolism in peritoneal dialysis (PD).

Methods: The PubMed, Cochrane Library, and EmBase databases were searched from inception to October 2016. Methodological quality assessment of the included studies was performed using the risk of bias tool of the Review Manager software. The meta-analysis was carried out with the Stata12.0 software. Subgroup analysis was performed by study design [randomized controlled trial (RCT) and non-RCT]. Odds ratios or standardized mean differences were used to assess the outcome measures, including intact parathyroid hormone (i-PTH) levels, serum total calcium amounts, ionized calcium levels, phosphate concentrations, and peritonitis episodes.

Results: Seven studies were enrolled in the synthesized analysis, including 4 RCTs and 3 non-RCTs. All studies compared 1.25 mmol/L and 1.75 mmol/L dialysate calcium for PD. Pooled analysis revealed that 1.75 mmol/L dialysate calcium significantly reduced i-PTH levels compared with the 1.25 mmol/L dose in PD patients. However, 1.25 mmol/L dialysate calcium was superior to the 1.75 mmol/L dose in decreasing the levels of serum total calcium and ionized calcium in PD patients. No significant differences in phosphate amounts and peritonitis episodes were observed between the two groups.

Conclusion: These findings indicated that 1.75 mmol/L dialysate calcium is more appropriate for PD patients with secondary hyperparathyroidism. Meanwhile, 1.25 mmol/L dialysate calcium is more favorable to PD patients with secondary hypercalcemia. However, further well-designed and high-quality studies are required to validate these findings.

Keywords: Dialysate calcium; Intact parathyroid hormone; Meta-analysis; Peritoneal dialysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process
Fig. 2
Fig. 2
Risk of bias graph of included studies
Fig. 3
Fig. 3
Risk of bias summary of included studies
Fig. 4
Fig. 4
Comparison of i-PTH levels at 1- to 2-year follow-up between the two groups
Fig. 5
Fig. 5
Comparison of total calcium levels at 1- to 2-year follow-up between the two groups
Fig. 6
Fig. 6
Comparison of ionized calcium levels at 1- to 2-year follow-up between the two groups
Fig. 7
Fig. 7
Comparison of phosphate levels at 1- to 2-year follow-up between the two groups
Fig. 8
Fig. 8
Comparison of peritonitis episodes at 1- to 2-year follow-up between the two groups
Fig. 9
Fig. 9
Galbraith plot for heterogeneity of total calcium levels at 1- to 2-year follow-up
Fig. 10
Fig. 10
Galbraith plot for heterogeneity of ionized calcium levels at 1- to 2-year follow-up
Fig. 11
Fig. 11
Galbraith plot for heterogeneity of phosphate levels at 1- to 2-year follow-up
Fig. 12
Fig. 12
Galbraith plot for heterogeneity of i-PTH at 1- to 2-year follow-up
Fig. 13
Fig. 13
Filled funnel plot with pseudo 95% confidence limits of total calcium levels

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