Hu X, et al. – This study analyzed the evidence from randomized controlled trials (RCTs) reporting the impact of paricalcitol on cardiovascular outcomes and renal function in patients with chronic kidney disease (CKD). While attenuating the risk of cardiovascular events in CKD patients, paricalcitol increased the risk of hypercalcemia in these subjects, without improving cardiac structure. Meanwhile, it cannot significantly reduce proteinuria level or protect renal function.

Methods

• Researchers searched MEDLINE, Embase, the Cochrane Library, and reference lists for RCTs comparing paricalcitol with placebo in stage 2–5 CKD (including pre-dialysis and renal replacement patients).
• They assessed study quality using the Cochrane quality assessment method.
• Results were summarized as risk ratios (RRs) for dichotomous outcomes or mean differences (MD) for continuous outcomes.

Results

• This analysis included 21 studies comprising 1894 patients.
• Findings demonstrated that, compared to placebo, paricalcitol reduced the risk of cardiovascular events (RR 0.55; 95% CI 0.35–0.87; p = 0.01), but the RR of hypercalcemia associated with paricalcitol was 6.50 (95% CI 3.21–13.15; p < 0.00001).
• Data reported that paricalcitol cannot significantly change systolic blood pressure and cardiac structure.
• Researchers noted that although proteinuria reduction was achieved more frequently with paricalcitol (RR 1.51; 95% CI 1.25–1.82; p < 0.0001), it did not significantly reduce proteinuria level compared to placebo.
• Results also highlighted that paricalcitol could not protect renal function to delay CKD progression, since it reduced the glomerular filtration rate (MD -3.15; 95% CI -4.35–-1.96; p < 0.0001) and elevated serum creatinine (MD 0.93; 95% CI 0.10–0.68; p = 0.008).