| Objective: To evaluate the clinical efficacy of Calcium-sensing receptor agonist Cinacalcet conbined vitamin D analog and phosphate binders in treating secondary hyperparathyroidism in patients with chronic kidney disease.To discuss the efficacy and safety of cinacalcet therapy on dialysis patients with SPTH.Methods: Pubmed,Medline and CBMdisc databases were searched for randomized controlled trails of using Calcium-sensing receptor agonist to treat secondary hyperparathyroidism in dialysis patients with chronic renal disease.According to the inclusion and exclusion criteria,the data were extracted from the included studies,the methodological quality were evaluated of the included studies,and the meta analysis was conducted using Revman5.3 software.Results: 11 included studies were identified 6811 patients enrolled.The results showed that Cinacalcet significantly reduced iPTH level(MD-290.80ng/ml,95%CI[-359.42,-222.17],P<0.00001),serum calcium levels(MD-0.80mg/dl,95%CI[-0.90,-0.70],P<0.00001)and serum phosphorus levels(MD-0.39mg/dl,95%CI[-0.55,-0.23],P<0.00001),more further toreached the KDOQI targets for CKD-MBD(populations reached target of iPTH≤300pg/ml RR 4.04,95%CI[3.29,4.96];populations reached target of serum calcium levels(8.4-9.5mg/dl)RR 2.07,95%CI[1.80,2.39];populations reached target of serum phosphorus levels(3.5-5.5mg/dl)RR 1.19,95%CI[1.06,1.33];populations reached target of calcium phosphorus product levels(<55mg2/dl2)RR 1.34,95%CI[1.21,1.49],the p value less than 0.01 above all),but it did not reduced the overall mortality(RR 0.95,95%CI[0.88,1.03],P=0.26)。Conclusion: Treatment of Cinacalcet combined vitamin D analog and phosphate binders could effectively induced iPTH,serum calcium levels and serum phosphorus levels in CKD patients with secondary hyperparathyroidism,and more further to reached the K/DOQI targets for CKD-MBD,but it did not reduced the overall mortality. |
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