西那卡塞联合活性维生素D治疗终末期肾病透析患者继发性甲状旁腺功能亢进症疗效及安全性的Meta分析

    Meta-analysis of the efficacy and safety of cinacalcet combined with active vitamin D in the treatment of secondary hyperparathyroidism in dialysis patients with end-stage renal disease

    • 摘要: 目的 评价西那卡塞联合活性维生素D治疗终末期肾病(ESRD)透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效及安全性。方法 计算机检索Pubmed、Embase、Cochrane图书馆临床对照试验资料库,搜索所有西那卡塞联合活性维生素D治疗ESRD透析患者SHPT的随机对照试验,检索时限为建库至2018年12月31日。采用RevMan 5.3软件进行Meta分析。结果 共纳入8项随机对照研究,包括2 169例患者。Meta分析结果显示,与单用活性维生素D相比,西那卡塞联合活性维生素D治疗组明显降低了透析患者血浆甲状旁腺激素水平RR=4.66,95%CI(2.27,9.55),P<0.01、血钙浓度MD=-0.81,95%CI(-0.92,-0.69),P<0.01、血磷浓度MD=-0.46,95%CI(-0.65,-0.26),P<0.01及钙磷乘积MD=-9.86,95%CI(-12.54,-7.19),P<0.01;而西那卡塞联合活性维生素D治疗对不良反应发生率RR=1.21,95%CI(0.82,1.77),P=0.33及全因死亡率RR=0.90,95%CI(0.54,1.48),P=0.67无显著影响。结论 西那卡塞联合活性维生素D治疗ESRD透析患者SHPT的疗效优于单用活性维生素D,且不增加不良反应发生率,但并不能降低全因死亡率。

       

      Abstract: Objective To evaluate the efficacy and safety of cinacalcet combined with active vitamin D in the treatment of secondary hyperparathyroidism(SHPT)in hemodialysis patients with end stage renal disease(ESRD).Methods The Pubmed,Embase and Cochrane Library clinical controlled trials database were searched.All the randomized controlled trials of cinacalcet combined with active vitamin D in the treatment of SHPT in ESRD dialysis patients were collected.The search time was from the database establishment date to December 31,2018.A meta-analysis was performed using RevMan 5.3 software.Results A total of 8 randomized controlled trials were included,including 2 169 patients.Meta-analysis showed that cinacalcet combined with active vitamin D treatment significantly reduced plasma parathyroid hormone in dialysis patients compared with active vitamin D aloneRR=4.66,95% CI(2.27,9.55),P<0.01,blood calcium concentrationMD=-0.81,95% CI(-0.92,-0.69),P<0.01,blood phosphorus concentrationMD=-0.46,95% CI(-0.65,-0.26),P<0.01,and calcium-phosphorus productMD=-9.86,95% CI(-12.54,-7.19),P<0.01.However,cinacalcet combined with active vitamin D had no significant effects on the incidence of adverse reactionsRR=1.21,95% CI(0.82,1.77),P=0.33 and all-cause mortalityRR=0.90,95% CI(0.54,1.48),P=0.67.Conclusions Cinacalcet combined with active vitamin D for the treatment of ESRD in dialysis patients with SHPT is superior to active vitamin D alone,and does not increase the incidence of adverse reactions,but does not reduce the all-cause mortality.

       

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