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A systematic review and meta-analysis of efficacy and safety of Calcimimetic agents in the treatment of secondary hyperparathyroidism in patients with chronic kidney disease.

Yiping Liu,Qian Yang,Guangyong Chen,Tianbiao Zhou

Published 2022 in Current pharmaceutical design

ABSTRACT

BACKGROUND Now some reports have pointed out that calcimimetics agents is effective in the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, but there is no detailed description of the advantages and disadvantages of calcimimetics agents of SHPT in CKD patients. We tried to pool the published data to verify the effectiveness of calcimimetics agents and to compare the advantages and disadvantages of cinacalcet compared with control in the treatment of SHPT in CKD patients. METHODS We included eligible studies of published papers from 1 Jan, 2000 to 31 Dec, 2020 in Medline, Pubmed and Web of science database, and the data were extracted for this meta-analysis. RESULTS 27 studies were eligible, and all the included studies were randomized controlled trial (RCT) trials including patients treated with long-term dialysis. The results indicated that calcimimetic agents can reduce the parathyroid hormone (PTH, pg/ml) level (WMD =-178.22, 95%CI: -238.57, -117.86, P<0.00001), calcium (Ca, mg/dl) level (WMD =-0.71, 95%CI: -0.86, -0.55, P<0.00001), phosphorus (P, mg/dl) level (WMD =-0.32, 95%CI: -0.55, -0.08, P=0.008), calcium-phosphorus product level (WMD =-7.73, 95%CI: -9.64, -5.82, P<0.00001). Calcimimetic agents increased the bone alkaline phosphatase (BSAP, ng/ml) change and rate of achieve target PTH, and reduced osteocalcin change and the rate of parathyroidectomy. Calcimimetic agents increased the total adverse events rate, the rate of hypocalcemia and gastrointestinal side effects (nausea, vomiting, abdominal pain and diarrhea), but there was no significant difference for serious adverse events between calcimimetic agent group and control group. CONCLUSION Calcimimetic agents can reduce the PTH level, Ca level, P level, calcium-phosphorus product level and do not increase the serious adverse events.

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