BackgroundSecondary hyperparathyroidism (SHPT) is a severe complication for dialysis patients. Vitamin D receptor activators (VDRAs) are used to treat SHPT, but the comparative efficacy and safety between paricalcitol and other vitamin D receptor activators for management of SHPT in dialysis patients has been unproven.MethodsWe searched PubMed, Embase, and the Cochrane Library for the time period through June 2017 to identify randomized controlled trials that evaluated paricalcitol compared with other VDRAs for treatment of SHPT. The primary outcome was the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline. Secondary outcomes included incidences of hypercalcemia and hyperphosphatemia. The random-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).ResultsEight studies (N = 759) were eligible for final inclusion. Compared with other VDRAs, no significant differences were found in the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline for paricalcitol treatment of SHPT in dialysis patients (RR, 1.01; 95% CI, 0. 87–1.18; p = 0.85). There were no differences in the incidence of hypercalcemia (RR, 0.95; 95% CI, 0.74–1.21; p = 0. 65) and hyperphosphatemia (RR, 0.94; 95% CI, 0.77–1.16; p = 0.58).ConclusionsThe presently available evidence is insufficient to draw a conclusion regarding whether paricalcitol therapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT. Large-sample, well-conducted, high-quality RCTs with patient-level outcomes (i.e., mortality) are urgently needed.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0691-6) contains supplementary material, which is available to authorized users.

Wu et al. CHM on deferring dialysis initiation for stage 5 CKD patients

Rechargeable aqueous zinc (Zn) metal batteries (ZMBs) have gained tremendous attention because of their intrinsic safety and low cost. However, the lifespan of ZMBs is seriously limited by severe Zn dendritic growth in aqueous electrolytes. Despite the feasibility of Zn deposition regulation by introducing Zn-alloying sites at the Zn plating surface, the activity of the Zn-alloying sites can be seriously reduced by side reactions in the aqueous environment. Here, we propose a facile but efficacious strategy to reinforce the activity of the Zn-alloying sites by introducing a low quantity of polar organic additive in the electrolyte that can be self-adsorbed on the Zn-alloying sites to form a molecular crowding layer against the parasitic water reduction during Zn deposition. As a consequence, stable cycling of the Zn anode can be maintained at such a multifunctional interfacial structure, arising from the synergism between the seeded low-overpotential Zn deposition on the stabilized Zn-alloying sites and a Zn2+ redistributing feature of the self-adsorbed molecular crowding layer. The interfacial design principle here can be widely employed due to the great variety of Zn-alloy and polar organic materials and potentially be applied to improve the performance of other aqueous metal batteries.