Active vitamin D increases the risk of hypercalcaemia in non-dialysis chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis.
Active vitamin D increases the risk of hypercalcaemia in non-dialysis chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis.
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DOI：
10.1093/ckj/sfab091
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发表时间：
2021-11
影响因子：
4.6
通讯作者：
Csomor PA
中科院分区：
文献类型：
--
作者：
Cozzolino M;Bernard L;Csomor PA
本研究评价了活性（1α-羟基化）维生素D（AVD）治疗对非透析慢性肾病（ND-CKD）和继发性甲状旁腺功能亢进（SHPT）患者高钙血症的影响。对PubMed、Embase和科克伦图书馆数据库进行了系统检索（截至2020年5月14日），以识别在ND-CKD和SHPT成人患者中进行单药口服AVD治疗的随机、安慰剂对照试验。仅每组≥30例受试者且持续时间≥6周的研究合格。关注的结局是发生高钙血症的受试者数量。使用综合荟萃分析软件（3.0版）对合格研究进行荟萃分析。确定了6项研究（5项评价帕立骨化醇，1项评价阿法骨化醇），涉及799例患者。治疗持续时间范围为16周至2年。帕立骨化醇的每周给药剂量为7 µ g（3项研究）和14 µg（2项研究）;阿法骨化醇的每周给药剂量为1.75-7.0 µg。在所有研究中，AVD组的高钙血症发生率为1.1-43.3%，安慰剂组为0-3.4%。6项研究的荟萃分析显示，与安慰剂相比，AVD与高钙血症相关的概率高6.6倍（比值比：6.63，95%置信区间：2.37，18.55; P < 0.001）。两项单独的敏感性分析（一项排除了一项确定为具有高偏倚风险的研究;第二项排除了两项占观察到的高钙血症事件大部分的研究）表明主要荟萃分析结果稳健。与安慰剂相比，AVD显着增加了伴有SHPT的ND-CKD患者高钙血症的风险。
This study evaluates the effects of active (1α-hydroxylated) vitamin D (AVD) therapy on hypercalcaemia in patients with non-dialysis chronic kidney disease (ND-CKD) and secondary hyperparathyroidism (SHPT). 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). 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 µg (two studies); the weekly dose of alfacalcidol was 1.75–7.0 µg. 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. Compared with placebo, AVD significantly increased the risk of hypercalcaemia among ND-CKD patients with SHPT.
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