Association of Drug Effects on Serum Parathyroid Hormone, Phosphorus, and Calcium Levels With Mortality in CKD: A Meta-analysis

摘要: Background Serum parathyroid hormone (PTH), phosphorus, and calcium levels are surrogate outcomes that central to the evaluation of drug treatments in chronic kidney disease (CKD). This systematic review evaluates evidence for correlation between effects on biochemical (PTH, calcium) all-cause cardiovascular mortality end points adults with CKD. Study Design Systematic meta-analysis. Setting & Population Adults Selection Criteria Studies Randomized trials reporting points. Intervention Drug interventions serum PTH, levels, including vitamin D compounds, phosphate binders, cinacalcet, bisphosphonates, calcitonin. Outcomes Correlation mortality. Results 28 studies (6,999 participants) reported both were eligible analysis. Associations corresponding weak imprecise. All coefficients less than 0.70, 95% credible intervals generally wide overlapped zero, consistent possibility no association. The exception was an inverse PTH mortality, which nominally significant (−0.64; interval, −0.85 to −0.15), but strength this association very Risk bias within available high, further reducing confidence summary correlations. Findings robust adjustment age, baseline level, allocation concealment, CKD stage, class. Limitations Low power analyses combining from many different comparisons incomplete data across studies. Conclusions weakly imprecisely correlated death setting Risks (patient-level outcome) cannot be inferred treatment-induced changes people Similarly, existing do not exclude a benefit treatment. Trials need address patient-centered evaluate effectiveness setting.