Benefits and Harms of Phosphate Binders in CKD: A Systematic Review of Randomized Controlled Trials

摘要: Background Phosphate binders are widely used to control serum phosphorus levels in patients with chronic kidney disease (CKD). We analyzed the effects of phosphate on biochemical and patient-level end points CKD. Study Design Systematic review meta-analysis by searching MEDLINE (1966 April 2009), EMBASE (1980 Cochrane Renal Group Specialised Register Central Controlled Trials (CENTRAL). Setting & Population Patients Selection Criteria for Studies Randomized controlled trials. Intervention binders. Outcomes Serum phosphorus, calcium, parathyroid hormone levels; incidence hypercalcemia; all-cause mortality; adverse effects. Results 40 trials (6,406 patients) were included. There was no significant decrease mortality (10 randomized trials; 3,079 patients; relative risk [RR], 0.73; 95% confidence interval [CI], 0.46 1.16), hospitalization, or end-of-treatment calcium-phosphorus product sevelamer compared calcium-based agents. a calcium salts hypercalcemia (RR, 0.47; CI, 0.36 0.62) increase gastrointestinal events comparison 1.39; 1.04 1.87). Compared agents, lanthanum significantly decreased levels, but similar levels. Effects acetate those carbonate. Existing data insufficient conclude differential impact any binder cardiovascular other outcome. Limitations Few long-term studies efficacy musculoskeletal morbidity, heterogeneity many surrogate outcomes, suboptimal reporting study methods determine trial quality. Conclusion Currently, there establish comparative superiority non–calcium-binding agents over calcium-containing such important outcomes as points. Additional still required examine phosphate-binding these mineral homeostasis pathway.