Cinacalcet best for mitigating vascular calcification among hemodialysis patients
Patients on hemodialysis often develop VC, which increases the risk of cardiovascular events and mortality. Currently, there is no definitive treatment for VC in this population. Sodium thiosulfate, bisphosphonates, and cinacalcet have been explored as potential therapeutic options, but their comparative efficacy remains unclear.Vascular calcification (VC) poses a significant challenge in the management of patients undergoing hemodialysis, with limited effective interventions available.
A recent network meta-analysis aimed to evaluate the clinical efficacy of sodium thiosulfate, bisphosphonates, and cinacalcet in treating VC in this patient population. This study was published in the journal BMC Nephrology by Lei He and colleagues. The meta-analysis included eleven randomized controlled trials (RCTs) involving 1083 hemodialysis patients. PubMed, Web of Science, the Cochrane Library, EMBASE, and China National Knowledge Internet (CNKI) were searched for eligible studies. Network meta-analysis was conducted using Stata 17.0 software to assess the efficacy of the three interventions.
The key findings of the study were:
Cinacalcet demonstrated a significant benefit in reducing vascular calcification compared to conventional therapy, with a standardized mean difference (SMD) of -0.59 (95% CI -0.95 to -0.24).
Sodium thiosulfate and bisphosphonates did not show significant efficacy in mitigating vascular calcification.
Cinacalcet had the highest surface under the cumulative ranking curve (SUCRA) value (88.5%), indicating its superiority over sodium thiosulfate (50.4%) and bisphosphonates (55.4%).
Cinacalcet was associated with a reduction in serum calcium levels (SMD -1.20; 95% CI -2.08 to -0.33) and showed a trend towards maintaining intact Parathyroid Hormone (iPTH) balance.
The meta-analysis suggests that cinacalcet may be more effective than sodium thiosulfate and bisphosphonates in mitigating vascular calcification in hemodialysis patients. Cinacalcet's mechanism of action involves reducing serum calcium levels and potentially maintaining iPTH balance. These findings highlight cinacalcet as a promising option for managing VC in clinical practice.
Reference:
He, L., Li, Y., Jin, J., Cheng, M., Bai, Y., & Xu, J. Comparative efficacy of sodium thiosulfate, bisphosphonates, and cinacalcet for the treatment of vascular calcification in patients with haemodialysis: a systematic review and network meta-analysis. BMC Nephrology,2024;25(1). https://doi.org/10.1186/s12882-024-03460-x
