Abstract
PurposeSecondary hyperparathyroidism (SHPT) is one of the most common abnormalities of mineral metabolism in patients with chronic kidney disease. We performed a meta-analysis to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis.MethodsThe meta-analysis was performed to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis by using the search terms ‘cinacalcet’ or ‘mimpara’ or ‘sensipar’ or ‘calcimimetic’ or ‘R586’ on MEDLINE and EMBASE (January 1990 to February 2012).ResultsFifteen trials were included, all of which were performed between 2000 and 2011 enrolling a total of 3387 dialysis patients. Our study showed that calcimimetic agents effectively ameliorated iPTH levels(WMD, −294.36 pg/mL; 95% CI, −322.76 to −265.95, P<0.001) in SHPT patients and reduced serum calcium (WMD, −0.81 mg/dL; 95% CI, −0.89 to −0.72, P<0.001) and phosphorus disturbances(WMD, −0.29 mg/dL; 95% CI, −0.41 to −0.17, P<0.001). The percentage of patients in whom there was a 30% decrease in serum iPTH levels by the end of the dosing was higher in cinacalcet group than that in control group(OR = 10.75, 95% CI: 6.65–17.37, P<0.001). However, no significant difference was found in all-cause mortality and all adverse events between calcimimetics and control groups(OR = 0.86, 95% CI: 0.46–1.60, P = 0.630; OR = 1.30, 95% CI: 0.78–2.18, P = 0.320, respectively). Compared with the control therapy, there was a significant increase in the episodes of hypocalcemia (OR = 2.46, 95% CI: 1.58–3.82, P<0.001), nausea (OR = 2.45, 95% CI: 1.29–4.66, P = 0.006), vomiting(OR = 2.78, 95% CI: 2.14–3.62, P<0.001), diarrhea(OR = 1.51, 95% CI: 1.04–2.20, P = 0.030) and upper respiratory tract infection (OR = 1.79, 95% CI: 1.20–2.66, P = 0.004)in calcimimetics group.ConclusionsCalcimimetic treatment effectively improved biochemical parameters of SHPT patients receiving dialysis without increasing all-cause mortality and all adverse events.
Highlights
Secondary hyperparathyroidism (SHPT) is one of the most common abnormalities of mineral metabolism in patients with chronic kidney disease (CKD), and is characterized by hyperplasia of the parathyroid glands and increased plasma levels of parathyroid hormone (PTH) [1]
Our study showed that calcimimetic agents effectively ameliorated intact PTH (iPTH) levels(WMD, 2294.36 pg/mL; 95% CI, 2322.76 to 2265.95, P,0.001) in SHPT patients and reduced serum calcium (WMD, 20.81 mg/dL; 95% CI, 20.89 to 20.72, P,0.001) and phosphorus disturbances(WMD, 20.29 mg/dL; 95% CI, 20.41 to 20.17, P,0.001)
The percentage of patients in whom there was a 30% decrease in serum iPTH levels by the end of the dosing was higher in cinacalcet group than that in control group(OR = 10.75, 95% CI: 6.65–17.37, P,0.001)
Summary
Secondary hyperparathyroidism (SHPT) is one of the most common abnormalities of mineral metabolism in patients with chronic kidney disease (CKD), and is characterized by hyperplasia of the parathyroid glands and increased plasma levels of parathyroid hormone (PTH) [1]. Vitamin D sterols have been shown to be effective in suppressing elevation of serum PTH levels, they increase serum P and Ca levels through stimulating gastrointestinal absorption [4], and only a few patients were able to achieve the recommended therapeutic targets [5]. The calcimimetic agents increase the sensitivity of CaR to extracellular Ca ion levels, leading to decreased PTH synthesis and secretion [8]. In 2004, the US Food and Drug Administration (FDA) approved cinacalcet (Sensipar) as the first calcimimetic drug for the treatment of SHPT.
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