Efficacy and safety of cinacalcet compared with other treatments for secondary hyperparathyroidism in patients with chronic kidney disease or end-stage renal disease: a meta-analysis

BackgroundIt is controversial for the effect and safety between cinacalcet and other treatments in treating secondary hyperparathyroidism for patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD).MethodsEmbase, PubMed, and Cochrane Library were searched through Feb 2017. 21 randomized controlled trials were included. We calculated the pooled mean difference (MD), relative risk (RR) and corresponding 95% confidence interval (CI).ResultPatients received calcimimetic agents had significantly decreased serum parathyroid hormone (MD=-259.24pg/mL, 95% CI: -336.23 to -182.25), calcium (MD=-0.92mg/dL, 95% CI: -0.98 to -0.85) and calcium phosphorus product (MD=-5.97mg(2)/dL(2), 95% CI: -9.77 to -2.16) concentration compared with control treatment. However, the differences in cardiovascular mortality and all-cause mortality between calcimimetics agents and control group were not statistically significant. The incidence of nausea (RR=2.13, 95% CI: 1.62 to 2.79), vomiting (RR=1.99, 95% CI: 1.78 to 2.23) and hypocalcemia (RR=10.10, 95% CI: 7.60 to 13.43) in CKD patients with calcimimetics agents was significantly higher than that with control treatment.ConclusionCinacalcet improved the biochemical parameters in CKD patients, but did not improve all-cause mortality and cardiovascular mortality. Moreover, cinacalcet can cause some adverse events.