Efficacy and Safety of Paricalcitol Therapy for Kidney Transplantation Recipients: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVES

To evaluate the efficacy and safety of paricalcitol in kidney transplant recipients while accounting for the small and clinically heterogeneous randomized evidence base.

MATERIALS AND

METHODS

The original multi-database search was supplemented by targeted PubMed and ClinicalTrials.gov surveillance through July 6, 2026. Eligible randomized trials comparing paricalcitol with inactive control were synthesized using random-effects models with small-sample-adjusted confidence intervals.

RESULTS

Six randomized trials involving 482 recipients were included. Paricalcitol reduced parathyroid hormone (SMD, -0.74; 95% CI, -1.23 to -0.24; p = .01; I² = 52%) but did not show a clear reduction in proteinuria (SMD, -0.22; 95% CI, -0.50 to 0.06; p = .10; I² = 0%). Serum calcium increased (SMD, 0.36; 95% CI, 0.03 to 0.68; p = .04; I² = 25%), and hypercalcemia was more frequent (RR, 3.71; 95% CI, 1.21 to 11.36; p = .03; I² = 0%). Serum phosphorus (SMD, 0.11; 95% CI, -0.18 to 0.40; p = .34; I² = 0%) and rejection events (RR, 0.78; 95% CI, 0.10 to 6.45; p = .67; I² = 0%) remained inconclusive.

CONCLUSIONS

Paricalcitol lowers short-term parathyroid hormone but increases serum calcium and hypercalcemia risk. Evidence for proteinuria, rejection, graft survival, and patient outcomes remains insufficient because the trials were few, heterogeneous, and short.