The impact of cinacalcet on the serum phosphorus, calcium and PTH levels in dialysis patients; a systematic review and meta-analysis

Abstract

Introduction: Cinacalcet is a medication prescribed to manage hypercalcemia and hyperparathyroidism in patients with chronic kidney diseases. The present study aims to evaluate the impact of cinacalcet on serum levels of calcium, phosphorus, and parathyroid hormone (PTH) in patients undergoing dialysis using a systematic review and meta-analysis approach. Materials and Methods: This study was conducted based on the PRISMA guidelines. A literature search without time restriction was performed on international databases, including Cochrane, Web of Science, Scopus, and PubMed. Data were analyzed using STATA 14 software at a significance level of P<0.05 for all tests. Results: The present meta-analysis involved twelve studies with a sample size of 1131 patients. A reduction was noted in the serum levels of calcium [SMD: -1.32 (95% CI: -2.64, -0.01)], PTH [SMD: -3.95 (95% CI: -6.53, -1.37)], phosphorus [SMD: -1.61 (95% CI: -3.01, -0.20)] and Ca×P [SMD: -5.33 (95% CI: -10.16, -0.49)] after cinacalcet use in dialysis patients. However, the variations in serum levels of alkaline phosphatase were non-significant [SMD: -0.09 (95% CI: -0.94, 0.77)]. In addition, the effectiveness of cinacalcet use on calcium serum level reduction in dialysis patients was verified at a daily dose of 30-60 mg [SMD: -0.83 (95% CI: -1.25, -0.42)] and consumption duration of 24 months [SMD: -1.26 (95% CI: -1.66, -0.87)]. Conclusion: The administration of cinacalcet significantly decreased the serum calcium, phosphorous, PTH, and Ca×P product in dialysis patients. The lowest and highest effects of cinacalcet were found for calcium and Ca×P products, respectively. The prescription of this drug appears more effective in improving hypercalcemia in dialysis patients. Registration: This investigation has been conducted in accordance with the PRISMA checklist, and its protocol was registered on the PROSPERO platform (ID: CRD42023428774).