Design: Systematic review and meta-analysis of six randomised trials
Population: 482 kidney transplant recipients
Primary outcome: PTH, proteinuria, calcium and safety
Effect: PTH SMD −0.74 (95% CI −1.23 to −0.24); proteinuria SMD −0.22 (−0.50 to 0.06); hypercalcaemia RR 3.71 (1.21–11.36)

A meta-analysis of six randomised trials (482 kidney transplant recipients) compared paricalcitol with inactive control.

Paricalcitol lowered parathyroid hormone (SMD −0.74, 95% CI −1.23 to −0.24) but did not clearly reduce proteinuria (SMD −0.22, −0.50 to 0.06). Serum calcium rose and hypercalcaemia was more frequent (RR 3.71, 1.21–11.36). Effects on rejection were inconclusive.

Persistent hyperparathyroidism after transplant is common and is often treated to protect bone and graft. These data support paricalcitol as a PTH-lowering option but not as an antiproteinuric agent, and show hypercalcaemia must be monitored. The trials were small and short, with no data on graft or patient survival.

Paricalcitol lowers PTH after transplant but has not been shown to reduce proteinuria
Check serum calcium regularly if paricalcitol is used — hypercalcaemia was nearly four times as common
There is no evidence yet of benefit on graft or patient survival
Weigh against alternatives for persistent post-transplant hyperparathyroidism

Why it matters

A surrogate win on PTH comes with a measurable harm and no proven outcome benefit.

The statistics, in plain English

A standardised mean difference of −0.74 is a moderate-to-large fall in PTH. The risk ratio for hypercalcaemia, 3.71, has a wide interval (1.21 to 11.36) because events were few.