Meta-analysis: vitamin D compounds in chronic kidney disease
Palmer SC, McGregor DO, Macaskill P, Craig JC, Elder GJ, Strippoli GF
Annals of internal medicine · 166 citas
Etiquetas de revisión
Financiación no declaradaDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2007-12-18 · Ann Intern Med · vol. 147 · número 12 · págs. 840–853
- Editorial
- American College of Physicians
- Citado
- 251 citas · más que el 100% de estudios similares · 19.4× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 104 trabajos
- Acceso
- De pago
- Áreas de investigación
- Parathyroid Disorders and Treatments · Vitamin D Research Studies · Dialysis and Renal Disease Management
- Palabras clave
- vitamin D, chronic kidney disease, secondary hyperparathyroidism, vitamin D analogs, parathyroid hormone, hypercalcemia, hyperphosphatemia, mineral metabolism, cardiovascular outcomes, mortality, vascular calcification, parathyroidectomy
- MeSH
- humans, kidney failure, chronic, hypercalcemia, hyperparathyroidism, secondary, parathyroid hormone, vitamins, vitamin d, drug administration schedule, randomized controlled trials as topic, hyperphosphatemia
6 autores
- Suetonia C. Palmer🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
- David O.R. McGregor🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
- Petra Macaskill🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
- Jonathan C. Craig🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
- Grahame J. Elder🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
- Giovanni FM Strippoli🇦🇺The University of Sydney; Children's Hospital at Westmead; National Health and Medical Research Council
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Vitamin D compounds are widely used to prevent and treat secondary hyperparathyroidism.
Purpose
To determine whether vitamin D therapy improves biochemical markers of mineral metabolism and cardiovascular and mortality outcomes in chronic kidney disease.
Data sources
MEDLINE (January 1966 to July 2007), EMBASE (January 1980 to July 2007), and Cochrane databases were searched without language restriction.
Study selection
Randomized, controlled trials of vitamin D compounds in chronic kidney disease were identified.
Data extraction
Two authors independently extracted data.
Data synthesis
Seventy-six trials were identified for inclusion; 3667 participants were enrolled. Vitamin D compounds did not reduce the risk for death, bone pain, vascular calcification, or parathyroidectomy. Compared with placebo, established vitamin D sterols were associated with an increased risk for hypercalcemia (relative risk, 2.37 [95% CI, 1.16 to 4.85]) and hyperphosphatemia (relative risk, 1.77 [CI, 1.15 to 2.74]) but did not show a consistent reduction in parathyroid hormone (PTH) levels. Compared with placebo, more recently developed vitamin D analogues were associated with hypercalcemia (relative risk, 5.15 [CI, 1.06 to 24.97]) but not hyperphosphatemia, and levels of PTH were reduced (weighted mean difference, -10.77 pmol/L [CI, -20.51 to -1.03 pmol/L]). For suppression of PTH, intravenous administration was superior to oral vitamin D, but higher intravenous doses were used.
Limitations
Few studies reported patient-level outcomes, including mortality (8 of 76 trials), and only 5 trials directly compared the effects of treatment with newer vitamin D compounds versus established ones. Heterogeneity in some comparisons remained unexplained by metaregression analyses.
Conclusion
Vitamin D compounds do not consistently reduce PTH levels, and beneficial effects on patient-level outcomes are unproven. The value of vitamin D treatment for people with chronic kidney disease remains uncertain.
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