| Objective: Hyperphosphatemia which is a frequent complication of chronic kidney disease(CKD),is related to the mortality of patients with CKD.In recent years,niacin and nicotinamide,which is member of the vitamin B family,has gradually become the new drug on the treatment of hyperphosphatemia in maintenance hemodialysis(MHD)patients.The positive effects were found on the treatment of hyperphosphatemia of MHD patients in many trials,but articles included in the published systematic review about niacin and nicotinamide for the treatment of hyperphosphatemia in MHD patients are not enough,and there are currently new publications.This review was conducted in order to assess the benefits and harms about niacin and nicotinamide for the treatment of hyperphosphatemia in MHD patients.Methods: According to the purpose of the study,we searched the Cochrane Library,Medline,Embase,Sinomed,CNKI,WANFANG,VIP.It was necessary to use manual searching for abstract and/or original text of possible articles.We contacted Pharmaceutical companies.All randomized controlled trials(RCTs)or quasi-RCTs comparing treatment of hyperphosphatemia of maintenance hemodialysis patients with niacin and nicotinamide against conventional treatment,no treatment and other drugs were included with administration,no consideration of dose,and duration.We extracted data and assessed the trial quality according to Jadad scale.Review Manager 5.3 software was used to analyze data.Outcomes including Phosphorus,Calcium,Calcium-phosphorus Product,Parathyroid Hormone,High Density Lipoprotein,Low Density Lipoprotein,Triglyceride,Cholesterol,Platelet were measured.We collected adverse effects information from the trials.The results of statistical analyses were expressed as weighted mean difference(WMD)and relative risk(RR)for dichotomous outcomesfor continuous outcomes,with 95% confidence intervals(CI).Results: Initially,209 articles were found,including 140 English papers,69 Chinese papers.Finally,13 randomized cotrolled clinical studies met the inclusion criteria.A total of 777 patients were enrolled.Compared with the control group,outcomes including Phosphorus,Calcium-Phosphorus Product and Low-Density Lipoprotein were significantly decreased,but High-Density Lipoprotein was significantly increased in the treatment group(niacin,nicotinamide),the difference was statistically significant(P<0.05).There was not significant difference in Calcium,Parathyroid Hormone,Triglyceride,Cholesteroland,Platelet between the treatment group and the control group(P>0.05).In drug safety,The trend of more events in the treatment group,such flushing,pruritus,skin burning,nausea,vomiting,dizziness,headache,diarrhea,numbness and other adverse reactions,reach significant difference(P=0.03),which will be relieved or disappeared after reducing or stopping drug.Conclusions: 1.The results of meta-analysis implied that,niacin and nicotinamide can reduce Phosphorus,Calcium-Phosphorus Product,Low Density Lipoprotein in maintenance hemodialysis patients.2.Niacin and nicotinamide can increase High-density Lipoprotein in maintenance hemodialysis patients,but have no effect on Calcium,Parathyroid Hormone,Triglyceride,Cholesterol and Platelet.3.In the study,serious adverse reactions of niacin and nicotinamide were not found,but someone in the treatment group may have flushing,pruritus,skin burning,nausea,vomiting,dizziness,headache,diarrhea,numbness and other symptoms,which will be relieved or disappeared after reducing or stopping drug.4.Given in a randomized controlled trial methodological quality existence insufficiency,the results of this review should be interpreted with caution.In order to improve the system to evaluate the reliability of the evidence,it is recommended that researchers conduct large-scale,multi-center randomized controlled trials in the future,paying attention to blinding,hidden implementation and observing the incidence of cardiovascular events,hospitalization rate of hemodialysis patients,and death endpoints through long-term follow-up. |
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