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Meta-analysis: the efficacy and safety of paricalcitol for the treatment of secondary hyperparathyroidism and proteinuria in chronic kidney disease.

AbstractINTRODUCTION:
Previous studies have demonstrated the safety and efficacy of using Paricalcitol for the treatment of secondary hyperparathyroidism (SHPT) in patients on dialysis. The aim of the current meta-analysis was to assess the safety and efficacy of Paricalcitol for the management of SHPT in patients with chronic kidney disease (CKD) not yet on dialysis. A secondary aim was to determine if sufficient data was available to assess the effect of Paricalcitol for the management of proteinuria.
METHODS:
A meta-analysis was conducted using the Cochrane Collaboration's RevMan 4.2 software.
RESULTS:
Paricalcitol is effective in lowering PTH in patients with CKD not yet on dialysis and is also effective in lowering proteinuria in diabetic CKD patients. However, we uncovered a safety signal identifying an elevated calcium phosphate product and a trend towards the development of hypercalcemia. A phosphate elevation was not demonstrated because the target used in the clinical studies was a P > 5.5 mg/dl, a value appropriate for dialysis patients and not CKD patients.
CONCLUSION:
Although Paricalcitol is effective in lowering PTH, we advise caution in the use of any active Vitamin D analogues in patients with CKD because of the potential risk of exacerbating vascular calcification.
AuthorsTianzhao Han, Gong Rong, Dayong Quan, Ying Shu, Zhu Liang, Ninglan She, Manli Liu, Bing Yang, Gong Cheng, Yongman Lv, Leonard Stern
JournalBioMed research international (Biomed Res Int) Vol. 2013 Pg. 320560 ( 2013) ISSN: 2314-6141 [Electronic] United States
PMID23509710 (Publication Type: Journal Article, Meta-Analysis)
Chemical References
  • Bone Density Conservation Agents
  • Ergocalciferols
  • Vitamin D
  • paricalcitol
Topics
  • Bone Density Conservation Agents (therapeutic use)
  • Ergocalciferols (adverse effects, therapeutic use)
  • Glomerular Filtration Rate
  • Humans
  • Hypercalcemia (chemically induced)
  • Hyperparathyroidism, Secondary (drug therapy)
  • Hyperphosphatemia (chemically induced)
  • Kidney Failure, Chronic (drug therapy)
  • Proteinuria (drug therapy)
  • Randomized Controlled Trials as Topic
  • Risk
  • Treatment Outcome
  • Vitamin D (analogs & derivatives)

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