Efficacy and safety of active vitamin D3 supplement in maintenance hemodialysis patients: a meta-analysis

Abstract

To evaluate the efficacy and safety of active vitamin D3 treatment in maintenance hemodialysis patients (MHD). We conducted a comprehensive search of the following databases: PubMed, Embase, Google scholar, CNKI, VIP, Wanfang data and CBM, to identify randomized controlled trials (RCTs) of active vitamin D3 supplementation in MHD patients up to November 2014. Meanwhile, we manually searched the reference lists of identified studies. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. Statistical analyses were performed using RevMan software, version 5.0. A total of 10 trials were included. There was a significant improvement in serum albumin (ALB) and an associated decline in PTH, alkaline phosphatase (ALP), C-reactive protein (CRP) and interleukin-6 (IL-6) in active vitamin D3-treated group (standardized mean difference (SMD) or weighted mean difference (95% CI): 0.47 (0.06, 0.88), -2.49 (-3.96, -1.02), -50.55 (-83.91, -17.19), -1.53 (-1.93, -1.12) and -4.71 (-7.48, -1.94), respectively). There was no statistical difference in the incidence of hyperphosphatemia, adverse events and mortality between the treatment and control group (RR (95% CI): 1.31 (0.96, 1.79), 0.85 (0.55, 1.32), 1.49 (0.80, 2.74), respectively). But there was a significant increase in serum calcium and calcium-phosphorus product in treatment group (RR (95% CI): 2.10 (1.18, 3.75) and 3.65 (1.45, 9.17), respectively). Currently available evidence suggests that active vitamin D3 is effective in treating secondary hyperparathyroidism, renal osteodystrophy, and improving malnutrition and microinflammation in MHD patients, without obvious adverse events. However, the occurrence of calcium and phosphate abnormalities should be closely monitored.