Effects Of Cinacalcet On Cardiovascular Mortality In Patients Undergoing Chronic Kidney Disease:a Meta-Analysis

Objective:Cinacalcet reduce serum parathyroid hormone levels in people with chronic kidney disease (CKD), but treatment effects on patient-relevant cardiovascular motality are uncertain. We conducted a systematic review and meta-analysis to summarize the benefits and harms of cinacalcet in adults with CKD and used cumulative meta-analysis to identify how evidence for cinacalcet treatment has developed in this clinical setting.Methods:We conducted a literature search to identify randomized trials that evaluating effects of calcimimetic therapy on mortality and adverse events in adults with CKD. Treatment group got therapy of cinacalcet plus conventional therapy, including vitamin D analogs and (or) phosphate binders. We evaluated these trials for inclusion, risk of bias, and abstracted relevant data.Results:Sixteen randomized controlled trials were included. In adults with GFR category G5 (GFR below 15 mL/min/1.73 m2) treated with dialysis, we found equivalent all-cause mortality (RR 0.97,95% CI 0.89 to 1.05) and cardiovascular mortality (RR 0.67, 95% CI 0.16 to 2.87). Toxicity profiles were quite different between the two regimens. Cinacalcet prevented surgical parathyroidectomy (RR 0.49,95% CI 0.40 to 0.59) and hypercalcaemia (RR 0.23,95% CI 0.05 to 0.97), but increased hypocalcaemia (RR 7.38,95% CI 5.43 to 10.03), nausea (RR 2.05,95% CI 1.54 to 2.75) and vomiting (RR 1.95,95% CI 1.74 to 2.18). Cinacalcet decreased serum iPTH (MD-276.47 pg/mL,95% CI-317.12 to-235.82) and calcium (MD-0.87 mg/dL,95% CI-0.96 to-0.77) levels, but had little or no effect on serum phosphorous levels (MD-5.19 mg2/dL2,95% CI-9.31 to-1.07). There're no significant heterogeneity and publication bias. Cumulative analysis found stable time-dependent trend. Analyses were limited by insufficient data in CKD stages 3-5 and kidney transplant recipients.Conclusion:Our study suggests, routine cinacalcet therapy can't improve cardiovascular or all-cause mortality. But it can reduce the need for parathyroidectomy and level of iPTH in adults treated with dialysis. Cinacalcet increases risks of nausea, vomiting and hypocalcaemia.