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.