Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

doi:10.1007/s00774-024-01500-y

Meta-Analysis

. 2024 May;42(3):316-325.

doi: 10.1007/s00774-024-01500-y. Epub 2024 Mar 27.

Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

Takuya Wakamatsu¹, Suguru Yamamoto², Koji Matsuo³, Masatomo Taniguchi⁴, Takayuki Hamano^{5

6}, Masafumi Fukagawa⁷, Junichiro James Kazama⁸

Affiliations

¹ Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan.
² Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan. yamamots@med.niigata-u.ac.jp.
³ Division of Nephrology, Niigata Shirone General Hospital, Niigata, Japan.
⁴ Fukuoka Renal Clinic, Fukuoka, Japan.
⁵ Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
⁶ Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁷ Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
⁸ Division of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.

PMID: 38536478
DOI: 10.1007/s00774-024-01500-y

Meta-Analysis

Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

Takuya Wakamatsu et al. J Bone Miner Metab. 2024 May.

. 2024 May;42(3):316-325.

doi: 10.1007/s00774-024-01500-y. Epub 2024 Mar 27.

Authors

Takuya Wakamatsu¹, Suguru Yamamoto², Koji Matsuo³, Masatomo Taniguchi⁴, Takayuki Hamano^{5

6}, Masafumi Fukagawa⁷, Junichiro James Kazama⁸

Affiliations

¹ Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan.
² Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan. yamamots@med.niigata-u.ac.jp.
³ Division of Nephrology, Niigata Shirone General Hospital, Niigata, Japan.
⁴ Fukuoka Renal Clinic, Fukuoka, Japan.
⁵ Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
⁶ Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁷ Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
⁸ Division of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.

PMID: 38536478
DOI: 10.1007/s00774-024-01500-y

Abstract

Introduction: This study aimed to assess the effectiveness of calcimimetics in reducing the risk of fractures in dialysis patients with secondary hyperparathyroidism (SHPT).

Material and methods: A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Library for articles published through December 9, 2023. The quality of each trial was evaluated using the Cochrane Collaboration tool. Meta-analysis was performed using a random-effects model, and effect measures across studies were synthesized. The risk ratio (RR) and 95% confidence interval (CI) were used to quantify the risk of fracture.

Results: We identified seven studies involving 6481 dialysis patients with SHPT. The administration of calcimimetics reduced fracture incidence compared to placebo or conventional treatment (RR: 0.50, 95% CI 0.29-0.88, p = 0.02). Calcimimetics demonstrated a low number needed to treat (NNT) to prevent an incident fracture (NNT: 47).

Conclusion: The use of calcimimetics offers a significant benefit in reducing the risk of fractures in patients undergoing dialysis with SHPT.

Keywords: Calcimimetics; Dialysis; Fracture; Meta-analysis; Parathyroid hormone.

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References

1. Wakasugi M, Kazama JJ, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Narita I (2013) Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab 31:315–321. https://doi.org/10.1007/s00774-012-0411-z - DOI - PubMed
1. Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399. https://doi.org/10.1046/j.1523-1755.2000.00178.x - DOI - PubMed
1. Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121. https://doi.org/10.1053/ajkd.2000.19812 - DOI - PubMed
1. Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL (2014) High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 85:166–173. https://doi.org/10.1038/ki.2013.279 - DOI - PubMed
1. Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, Andreucci VE, Fukagawa M, Frimat L, Mendelssohn DC, Port FK, Pisoni RL, Robinson BM (2015) Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol: CJASN 10:98–109. https://doi.org/10.2215/CJN.12941213 - DOI - PubMed

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[1] Wakasugi M, Kazama JJ, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Narita I (2013) Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab 31:315–321. https://doi.org/10.1007/s00774-012-0411-z - DOI - PubMed

[2] Wakasugi M, Kazama JJ, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Narita I (2013) Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab 31:315–321. https://doi.org/10.1007/s00774-012-0411-z - DOI - PubMed

[3] Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399. https://doi.org/10.1046/j.1523-1755.2000.00178.x - DOI - PubMed

[4] Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399. https://doi.org/10.1046/j.1523-1755.2000.00178.x - DOI - PubMed

[5] Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121. https://doi.org/10.1053/ajkd.2000.19812 - DOI - PubMed

[6] Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121. https://doi.org/10.1053/ajkd.2000.19812 - DOI - PubMed

[7] Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL (2014) High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 85:166–173. https://doi.org/10.1038/ki.2013.279 - DOI - PubMed

[8] Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL (2014) High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 85:166–173. https://doi.org/10.1038/ki.2013.279 - DOI - PubMed

[9] Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, Andreucci VE, Fukagawa M, Frimat L, Mendelssohn DC, Port FK, Pisoni RL, Robinson BM (2015) Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol: CJASN 10:98–109. https://doi.org/10.2215/CJN.12941213 - DOI - PubMed

[10] Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, Andreucci VE, Fukagawa M, Frimat L, Mendelssohn DC, Port FK, Pisoni RL, Robinson BM (2015) Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol: CJASN 10:98–109. https://doi.org/10.2215/CJN.12941213 - DOI - PubMed

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Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

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Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

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