Efficacy and safety of paricalcitol therapy for chronic kidney disease: A meta-analysis

Abstract

Background and objectivesObservational data indicate that newer vitaminDcompounds such as paricalcitol can suppress serum intact parathyroid hormone (iPTH) and reduce proteinuria in patients with CKD. To systematically evaluate the efficacy and safety of paricalcitol for CKD, we conducted a meta-analysis of the published randomized controlled trials (RCTs). Design, setting, participants, & measurements: MEDLINE, Embase, the Cochrane Library, and article reference lists were searched for RCTs that compared paricalcitol with placebo in the treatment of patients with stage 2-5 CKD. The quality of the studieswas evaluated using the Jadadmethod. The results are summarized as risk ratios (RRs) for dichotomous outcomes or mean differences for continuous outcomes. Results Nine studies (832 patients) were included. Compared with placebo, paricalcitol suppressed serum iPTH (RR, 6.37; 95% confidence interval [95% CI], 4.64-8.74; P <0.001) and reduced proteinuria (RR, 1.68; 95% CI, 1.25-2.25; P < 0.001). Comparedwith the control group, the RR for hypercalcemia associatedwith paricalcitol use was 2.25 (95% CI, 0.81-6.26; P=0.12). Patients receiving paricalcitol therapy did not have an increased risk of endocrine system and cardiovascular system adverse effects (RR, 1.07; 95% CI, 0.84-1.36; P=0.58). Conclusions: We confirm that paricalcitol suppresses iPTH and lowers proteinuria in patientswith stage 2-5CKD without an increased risk of adverse events. A trend toward increased hypercalcemia did not reach statistical significance, but may be clinically relevant. A randomized trial is needed to determine if paricalcitol affects the development of ESRD or mortality. © 2012 by the American Society of Nephrology.