Vitamin D Receptor Activators and Clinical Outcomes in Chronic Kidney Disease

Table 2

Suppression of PTH and effects on calcium and phosphate levels: paricalcitol versus placebo and paricalcitol versus calcitriol.

Author	Year	Study	Outcome 1	Outcome 2
Coyne et al. [11]	2006	Three randomized, placebo-controlled, phase-3 trials were conducted in 220 patients with stage 3 and 4 CKD with secondary hyperparathyroidism.; 24-week studies	Decreases in PTH levels of 30% or greater in 91% of paricalcitol versus 13% of placebo patients (𝑃<.001)	Incidences of hypercalcemia, hyperphosphatemia, and elevated Ca × P were not significantly different between groups
Martin et al. [12]	1998	3 double-blind RCTs; 𝑛=78 dialysis patients 12-week study	27 of 40 patients receiving paricalcitol (68%) had a 30% decrease in serum PTH for 4 consecutive weeks, versus 3 of 38 patients (8%) receiving placebo (𝑃<.001)	No evidence of hypercalcemia and hyperphosphatemia
Lindberg et al. [13]	2001	Open-label study; 𝑛=164 dialysis patients.; 13-month study	Mean PTH levels fell into target range (100–300 pg/mL) by month 5	Serum calcium and phosphorus were in normal range
Sprague et al. [14]	2003	Multicenter, double-blind RCT; 𝑛=263 dialysis patients.; 32-week study	Paricalcitol patients had a ≥50% and faster reduction in baseline PTH versus calcitriol patients (87 versus 107 days). Paricalcitol patients reached a therapeutic PTH range in 18 weeks versus calcitriol patients who never reached the target range	Hypercalcemic episodes were 18% for paricalcitol versus 33% for calcitriol (𝑃=.008)
Mittman et al. [15]	2004	Retrospective study; 𝑛=101 dialysis patients 24-month study	PTH levels were significantly lower for paricalcitol versus calcitriol (247 versus 190 pg/mL)	Number of hypercalcemic episodes were 111 for paricalcitol versus 69 for calcitriol; number of episodes of hyperphosphatemia were 225 for paricalcitol versus 186 for calcitriol
Coyne et al. [16]	2002	Crossover study; 𝑛=10 dialysis patients 36-hour study	Suppression of PTH at 36 hours was significantly greater after administration of 160 μg of paricalcitol (63.6%  ±  2.3%) versus calcitriol	Ca × P product increased more after calcitriol administration than after a 6- or 8-fold greater dose of paricalcitol
Lund et al. [17]	2010	Single-center, double-blind, active-controlled, randomized, crossover trial. 𝑛=22 hemodialysis patients	Fractional intestinal calcium absorption was significantly lower after paricalcitol (0.135 ± 0.006) versus calcitriol (0.158 ± 0.006, 𝑃=.022)
Mittman et al. [18]	2010	2-year, single-center crossover study; 𝑛=73 hemodialysis patients converted from calcitriol to paricalcitol using a 1 : 3 conversion ratio	Conversion from calcitriol to paricalcitol resulted in lower serum calcium (𝑃<.001), lower serum phosphorus (𝑃<.05), reduced PTH (𝑃=.001) and reduced serum alkaline phosphatase (𝑃<.001)