Effects and Safety of Calcimimetics in End Stage Renal Disease Patients with Secondary Hyperparathyroidism: A Meta-Analysis

Purpose: Secondary hyperparathyroidism (SHPT) is one of the most common abnormalities of mineral metabolism in patients with chronic kidney disease. We performed a meta-analysis to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis. Methods: The meta-analysis was performed to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis by using the search terms 'cinacalcet' or 'mimpara' or 'sensipar' or 'calcimimetic' or 'R586' on MEDLINE and EMBASE (January 1990 to February 2012). Results: Fifteen trials were included, all of which were performed between 2000 and 2011 enrolling a total of 3387 dialysis patients. Our study showed that calcimimetic agents effectively ameliorated iPTH levels(WMD, -294.36 pg/mL; 95% CI, -322.76 to -265.95, P<0.001) in SHPT patients and reduced serum calcium (WMD, -0.81 mg/dL; 95% CI, -0.89 to -0.72, P<0.001) and phosphorus disturbances(WMD, -0.29 mg/dL; 95% CI, -0.41 to -0.17, P<0.001). The percentage of patients in whom there was a 30% decrease in serum iPTH levels by the end of the dosing was higher in cinacalcet group than that in control group(OR = 10.75, 95% CI: 6.65-17.37, P<0.001). However, no significant difference was found in all-cause mortality and all adverse events between calcimimetics and control groups(OR = 0.86, 95% CI: 0.46-1.60, P = 0.630; OR = 1.30, 95% CI: 0.78-2.18, P = 0.320, respectively). Compared with the control therapy, there was a significant increase in the episodes of hypocalcemia (OR = 2.46, 95% CI: 1.58-3.82, P<0.001), nausea (OR = 2.45, 95% CI: 1.29-4.66, P = 0.006), vomiting(OR = 2.78, 95% CI: 2.14-3.62, P<0.001), diarrhea(OR = 1.51, 95% CI: 1.04-2.20, P = 0.030) and upper respiratory tract infection (OR = 1.79, 95% CI: 1.20-2.66, P = 0.004) in calcimimetics group. Conclusions: Calcimimetic treatment effectively improved biochemical parameters of SHPT patients receiving dialysis without increasing all-cause mortality and all adverse events.