Abstract:

[Abstract] Objective: Evaluating the effectiveness and safety of alfacalcidol pulse treatment, and providing a new therapeutic strategy for the treatment of secondary hyperparathyroidism. Methodology: Original literatures for this review were searched with databases of PubMed, Embase, CNKI and CBMdisc from databases establishment to September 2013. At the same time, the relevant literature references were to retrieved. All the randomized control studies on the pulse alfacalcidol for the treatment of secondary hyperparathyroidism in patients haemodialysis were included. Meta -analysis was conducted using Review Manager 5.2 software. Results: Eighteen randomized controlled studies were included, finally 12 articles were received in the Meta-analysis, including 340 patients with pulse alfacalcidol treatment, and 323 patients for control.The change value was explained by SMD before and after treatment of the observation target (the product of iPTH, calcium, phosphate, calcium phosphorous and alkaline phosphatase) in treatment group and control group. When analyzing stratifiedly iPTH, the paper took OR as effect indicators. Meta showed the SMD of the treatment group and the control group before and after treatment of parathormone (-0.30；95%CI is -0.53，-0.07), P=0.01<0.05, and the difference had statistical significance. Compared with the control group, the level of iPTH was declines obviously in the treatment group. The heterogeneity of articles was tested by analyzing sensitivity, and no changes were found before and after treatment after removing a few articles with inferior quality. After subgroup analyzing iPTH〈500pg/ml and 〉500pg/ml, the experiment made a conclusion that no matter which level iPTH was. Compared with the control group, the levels of iPDH was decreased more obviously, and the difference has the statistical significance. It showed that the SMD of serum calcium in treatment group before and after treatment and control (-0.10；95%CI was -0.25～0.06, P=0.22) was no significant difference. It also showed that the SMD of serum phosphate in treatment group before and after treatment and control (0.04；95%CI is -0.30～0.37, P=0.830 was no statistical significance. Conclusion: Pulse alfacalcidol treatment resulted in decreasing iPTH more obviously in patients with hemodialysis, and did not cause hypercalcemia, hyperphosphatemia and other side effects.

Key words: Afacalcidol,  Secondary hyperparathyroidism, Randomized control study, Meta-analysis