Background. This study evaluates the effects of active (1a-hydroxylated) vitamin D (AVD) therapy on hypercalcaemia in patients with non-dialysis chronic kidney disease (ND-CKD) and secondary hyperparathyroidism (SHPT). Methods. A systematic search of the PubMed, Embase and Cochrane Library databases (up to 14 May 2020) was performed to identify randomized, placebo-controlled trials of single-agent, oral AVD therapies in adults with ND-CKD and SHPT. Only studies with 30 participants per arm and 6 weeks in duration were eligible. The outcome of interest was the number of subjects with an episode of hypercalcaemia. A meta-analysis of eligible studies was conducted using Comprehensive Meta- Analysis software (version 3.0). Results. Six studies (five evaluating paricalcitol, one evaluating alfacalcidol) involving 799 patients were identified. Treatment durations ranged from 16 weeks to 2 years. The weekly doses of paricalcitol administered were 7 (three studies) and 14 mg (two studies); the weekly dose of alfacalcidol was 1.75—7.0 mg. Across all studies, rates of hypercalcaemia were 1.1—43.3% with AVD versus 0—3.4% with placebo. Meta-analysis of the six studies showed that AVD was associated with a 6.6-fold greater probability of hypercalcaemia versus placebo (odds ratio: 6.63, 95% confidence interval: 2.37, 18.55; P <0.001). Two separate sensitivity analyses (one excluded a study identified as having a high risk of bias; the second excluded two studies that accounted for a large proportion of observed hypercalcaemia events) indicated the primary meta-analysis findings were robust. Conclusions. Compared with placebo, AVD significantly increased the risk of hypercalcaemia among ND-CKD patients with SHPT.

Active vitamin D increases the risk of hypercalcaemia in non-dialysis chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis / M. Cozzolino, L. Bernard, P.A. Csomor. - In: CLINICAL KIDNEY JOURNAL. - ISSN 2048-8505. - (2021 Jul 19), pp. 1-7. [Epub ahead of print] [10.1093/ckj/sfab091]

Active vitamin D increases the risk of hypercalcaemia in non-dialysis chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Cozzolino, Mario;
2021-07-19

Abstract

Background. This study evaluates the effects of active (1a-hydroxylated) vitamin D (AVD) therapy on hypercalcaemia in patients with non-dialysis chronic kidney disease (ND-CKD) and secondary hyperparathyroidism (SHPT). Methods. A systematic search of the PubMed, Embase and Cochrane Library databases (up to 14 May 2020) was performed to identify randomized, placebo-controlled trials of single-agent, oral AVD therapies in adults with ND-CKD and SHPT. Only studies with 30 participants per arm and 6 weeks in duration were eligible. The outcome of interest was the number of subjects with an episode of hypercalcaemia. A meta-analysis of eligible studies was conducted using Comprehensive Meta- Analysis software (version 3.0). Results. Six studies (five evaluating paricalcitol, one evaluating alfacalcidol) involving 799 patients were identified. Treatment durations ranged from 16 weeks to 2 years. The weekly doses of paricalcitol administered were 7 (three studies) and 14 mg (two studies); the weekly dose of alfacalcidol was 1.75—7.0 mg. Across all studies, rates of hypercalcaemia were 1.1—43.3% with AVD versus 0—3.4% with placebo. Meta-analysis of the six studies showed that AVD was associated with a 6.6-fold greater probability of hypercalcaemia versus placebo (odds ratio: 6.63, 95% confidence interval: 2.37, 18.55; P <0.001). Two separate sensitivity analyses (one excluded a study identified as having a high risk of bias; the second excluded two studies that accounted for a large proportion of observed hypercalcaemia events) indicated the primary meta-analysis findings were robust. Conclusions. Compared with placebo, AVD significantly increased the risk of hypercalcaemia among ND-CKD patients with SHPT.
alfacalcidol, calcium, kidney failure, parathyroid hormone, paricalcitol, randomized-controlled trials, SHPT, vitamin D deficiency;
Settore MED/14 - Nefrologia
CLINICAL KIDNEY JOURNAL
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/858656
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