Efficacy And Safety Of Cinacalcet Therapy For Renal Transplant Patients With Secondary Hyperparathyroidism—A Systematic Review And Meta-analysis

Objective:To evaluate the efficacy and safety of Cinacalcet therapy for renal transplant patients with secondary hyperparathyroidism.Methods:Up to December,2016,Medline,Embase and Cochrane Library were systematically searched for observational studies and RCTs that studied with Cinacalcet therapy’s effects on renal transplant patients with SHPT.23 studies met the criterion,including 21 observational studies and 2 RCTs.The data analysis software was Review Manager 5.3.Results:Totally 23 studies of 610 patients were included.Compared with pre-treatment,Cinacalcet significantly decrease patients’ serum Ca(MD=0.29mmol/L,95%CI=0.26 to 0.33,P<0.00001),PTH(MD=91.60pg/mL,95%CI=66.57 to 116.62,P<0.00001),and eGFR(MD=3.61mL/min/1.73m2,95%CI=1.57 to 5.65,P=0.0005).Cinacalcet significantly increase patients’ serum P(MD=0.14mmol/L,95%CI=0.10 to 0.18,P<0.00001).However,no significant effects were found in serum ALP or serum Cr.Further subgroup analysis found that,when the follow-up period was shorter than 6 months,the Cinacalcet therapy had significant reduction on eGFR(MD=2.21 mL/min/1.73m2,95%CI=0.38 to 4.04),while no significant change was found when the follow-up period was longer than 6 months.Conclusion:Cinacalcet has a significant curative effects for renal transplant patients with SHPT,while renal function decrease in the early stage and recover later.The mechanism of Cinacalcet’s effect on renal function needs further study.