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Submitted: 23 Apr 2023
Accepted: 18 Aug 2023
ePublished: 31 Aug 2023
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J Renal Inj Prev. 2023;12(4): e32207.
doi: 10.34172/jrip.2023.32207

Scopus ID: 85174700303
  Abstract View: 833
  PDF Download: 508

Meta-analysis

The effect of cinacalcet on hypercalcemia in kidney transplant patients with hyperparathyroidism: systematic review and meta-analysis

Hanie Fooladi 1 ORCID logo, Fatemeh Vashahi Torfi 2 ORCID logo, Ali Khodaparast 3 ORCID logo, Sara Abbasian 4 ORCID logo, Noorbakhsh Alivand 5 ORCID logo, Mohamad Khaledi 1 ORCID logo, Soleyman Alivand 6 ORCID logo, Farshad Gharebakhshi 7 ORCID logo, Moein Shakerian 8* ORCID logo

1 Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2 Student Research Committee, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Nephrology, Faculty of Medicine, Birjand University of Medical Sciences (BUMS), Birjand, Iran
4 Department of Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Nutrition, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
6 Department of Biostatistical and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
7 Department of Radiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
8 Department of Veterinary Medicine, Garmsar branch of Islamic Azad University, Garmsar, Iran
*Corresponding Author: Moein Shakerian, Email: Moein.shakerian@yahoo.com

Abstract

Introduction: Following renal transplantation, patients with end-stage renal disease develop parathyroid dysfunction and electrolyte abnormalities, including calcium and phosphate levels. However, cinacalcet is one of the most used medications for hypercalcemia. Therefore, the present systematic review and meta-analysis aimed to investigate the effect of cinacalcet administration on hypercalcemia in patients with renal transplantation.

Materials and Methods: The online databases of Cochrane, Web of Science, Scopus, and PubMed were searched until April 2023 using validated keywords. Moreover, PRISMA was used for qualitatively evaluating the studies since the study protocol was registered on the PROSPERO website. In addition, data analysis was conducted using Stata version 14, and the significance level was set at 0.05.

Results: The present meta-analysis included 26 studies (24 cohort studies and two randomized clinical trials) investigating 602 patients with renal transplantation and hyperparathyroidism. According to our findings, cinacalcet reduced the serum calcium (MD: -2.24, 95% CI: -2.82, -1.67), parathormone (SMD: -0.85, 95% CI: -1.15, -0.54), and alkaline phosphatase levels (SMD: -0.45, 95% CI: -0.91, -0.01). Moreover, 30-60 mg of cinacalcet per day effectively treated hypercalcemia (SMD: -2.77, 95% CI: -3.57, -1.98), while other doses were not significantly effective. Furthermore, the effect of cinacalcet was investigated in patients using the medication for less than six months (SMD: -2.55, 95% CI: -4.25, -0.86), 12-18 months (SMD: -2.60, 95% CI: -3.53, -1.67), and more than 24 months (SMD: -1.71, 95% CI: -2.54, -0.88). Finally, the effect of cinacalcet was the highest in the patients who were 60-64 years old compared to other age groups (SMD: -3.59, 95% CI: -5.14, -2.04).

Conclusion: Cinacalcet could improve hypercalcemia and hyperparathyroidism in patients with renal transplantation. Moreover, the effect of cinacalcet had a direct and positive relationship with the patient’s age.

Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42023428620) and Research Registry (UIN: reviewregistry1667) website.


Implication for health policy/practice/research/medical education:

This meta-analysis was conducted on 26 studies and according to our findings, cinacalcet could decrease the serum levels of calcium, parathormone, and alkaline phosphatase in patients with renal transplantation. Thus, this medication treated the hypercalcemia and hyperparathyroidism in these patients. However, it did not show any significant effect on estimated glomerular filtration rate, Ca×P products and serum levels of creatinine, albumin, and 25-OH vitamin D. The effect of cinacalcet on calcium levels increased with the age of the patients.

Please cite this paper as: Fooladi H, Vashahi Torfi F, Khodaparast A, Abbasian S, Alivand N, Khaledi M, Alivand S, Gharebakhshi F, Shakerian M. The effect of cinacalcet on hypercalcemia in kidney transplant patients with hyperparathyroidism: systematic review and meta-analysis. J Renal Inj Prev. 2023;12(4): e32207. doi: 10.34172/jrip.2023.32207.

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