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Effect of active vitamin D on cardiovascular outcomes in predialysis chronic kidney diseases: A systematic review and meta‐analysis
Author(s) -
Li XiaoHua,
Feng Li,
Yang ZhenHua,
Liao YunHua
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12505
Subject(s) - medicine , vitamin d and neurology , paricalcitol , kidney disease , placebo , renal function , blood pressure , calcitriol , cochrane library , proteinuria , meta analysis , randomized controlled trial , cardiology , kidney , calcium , parathyroid hormone , pathology , secondary hyperparathyroidism , alternative medicine
Aim Vitamin D deficient patients present an increased risk of cardiovascular disease. We conducted this systematic review and meta‐analysis to evaluate the effect of active vitamin D analogue on cardiovascular outcomes in predialysis chronic kidney disease. Methods P ubmed, E mbase, the C ochrane L ibrary, CNKI , and article reference lists were searched for randomized controlled trials ( RCTs) that compared active vitamin D analogues with placebo or no treatment for patients with predialysis chronic kidney disease. A meta‐analysis was conducted using the standard methods consistent with the P referred R eporting I tems for S ystematic R eviews and M eta‐ A nalyses ( PRISMA ) guidelines. R eviewer M anager S oftware, ver. 5.2, was used. Results Seven RCTs (five studies with paricalcitol and two studies with calcitriol, 731 patients) were included. Compared with control groups, active vitamin D reduced the incidence of cardiovascular events ( RR , 0.27; 95% CI , 0.13–0.59), induced an increase in those with proteinuria reduction ( RR , 1.9; 95% CI , 1.34–2.71), but did not alter left ventricular mass index and systolic function ( MD , 0.42 g/m 2.7 ; 95% CI , −0.23–1.07 g/m 2.7 , P = 0.21 for left ventricular mass index and MD , −0.33; 95% CI , −0.74–0.07, P = 0.1 for left ventricular ejection fraction). Neither systolic blood pressure nor diastolic blood pressure was reduced by active vitamin D ( MD , 0.3 mmHg; 95% CI , −4.95–5.56 mmHg; MD , −0.24 mmHg; 95% CI : −6.21–5.72 mmHg, respectively). Increased probability of hypercalcaemia after paricalcitol therapy was found ( RR , 7.85; 95% CI , 2.92–21.10). Conclusion Active vitamin D reduced the incidence of cardiovascular events and induced a reduction in proteinuria, but its long‐term effect on cardiac structure and function needed further confirmation. Increased probability of hypercalcaemia after paricalcitol therapy was found.