Background: Secondary hyperparathyroidism (SHPT) is a severe complication for dialysis patients. Vitamin D\nreceptor activators (VDRAs) are used to treat SHPT, but the comparative efficacy and safety between paricalcitol and\nother vitamin D receptor activators for management of SHPT in dialysis patients has been unproven.\nMethods: We searched PubMed, Embase, and the Cochrane Library for the time period through June 2017 to\nidentify randomized controlled trials that evaluated paricalcitol compared with other VDRAs for treatment of SHPT.\nThe primary outcome was the percentage of patients with target reduction of intact parathyroid hormone (iPTH)\nfrom baseline. Secondary outcomes included incidences of hypercalcemia and hyperphosphatemia. The randomeffects\nmodel was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).\nResults: Eight studies (N = 759) were eligible for final inclusion. Compared with other VDRAs, no significant differences\nwere found in the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline for\nparicalcitol treatment of SHPT in dialysis patients (RR, 1.01; 95% CI, 0. 87ââ?¬â??1.18; p = 0.85). There were no differences in\nthe incidence of hypercalcemia (RR, 0.95; 95% CI, 0.74ââ?¬â??1.21; p = 0. 65) and hyperphosphatemia (RR, 0.94; 95% CI,\n0.77ââ?¬â??1.16; p = 0.58).\nConclusions: The presently available evidence is insufficient to draw a conclusion regarding whether paricalcitol\ntherapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT. Largesample,\nwell-conducted, high-quality RCTs with patient-level outcomes (i.e., mortality) are urgently needed.
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