Abstract | BACKGROUND: PURPOSE: DATA SOURCES: MEDLINE (January 1966 to July 2007), EMBASE (January 1980 to July 2007), and Cochrane databases were searched without language restriction. STUDY SELECTION: DATA EXTRACTION: Two authors independently extracted data. DATA SYNTHESIS: Seventy-six trials were identified for inclusion; 3667 participants were enrolled. Vitamin D compounds did not reduce the risk for death, bone pain, vascular calcification, or parathyroidectomy. Compared with placebo, established vitamin D sterols were associated with an increased risk for hypercalcemia (relative risk, 2.37 [95% CI, 1.16 to 4.85]) and hyperphosphatemia (relative risk, 1.77 [CI, 1.15 to 2.74]) but did not show a consistent reduction in parathyroid hormone (PTH) levels. Compared with placebo, more recently developed vitamin D analogues were associated with hypercalcemia (relative risk, 5.15 [CI, 1.06 to 24.97]) but not hyperphosphatemia, and levels of PTH were reduced (weighted mean difference, -10.77 pmol/L [CI, -20.51 to -1.03 pmol/L]). For suppression of PTH, intravenous administration was superior to oral vitamin D, but higher intravenous doses were used. LIMITATIONS: Few studies reported patient-level outcomes, including mortality (8 of 76 trials), and only 5 trials directly compared the effects of treatment with newer vitamin D compounds versus established ones. Heterogeneity in some comparisons remained unexplained by metaregression analyses. CONCLUSION:
Vitamin D compounds do not consistently reduce PTH levels, and beneficial effects on patient-level outcomes are unproven. The value of vitamin D treatment for people with chronic kidney disease remains uncertain.
|
Authors | Suetonia C Palmer, David O McGregor, Petra Macaskill, Jonathan C Craig, Grahame J Elder, Giovanni F M Strippoli |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 147
Issue 12
Pg. 840-53
(Dec 18 2007)
ISSN: 1539-3704 [Electronic] United States |
PMID | 18087055
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Parathyroid Hormone
- Vitamins
- Vitamin D
|
Topics |
- Drug Administration Schedule
- Humans
- Hypercalcemia
(chemically induced)
- Hyperparathyroidism, Secondary
(prevention & control)
- Hyperphosphatemia
(chemically induced)
- Kidney Failure, Chronic
(blood, complications)
- Parathyroid Hormone
(blood)
- Randomized Controlled Trials as Topic
- Vitamin D
(adverse effects, therapeutic use)
- Vitamins
(adverse effects, therapeutic use)
|