A Cochrane review [Abstract] 1 included 104 studies with a total of 13 744 subjects. Phosphate binders are widely used to slow the development and progression mineral and bone disorder in chronic kidney disease (CKD). In CKD grade 2 to 5, compared with placebo or usual care, sevelamer, lanthanum, iron and calcium-based phosphate binders had uncertain or inestimable effects on death (all causes), cardiovascular death, myocardial infarction, stroke, fracture, or coronary artery calcification (table T1). They reduced serum phosphorus levels compared to placebo.
| Outcome | Relative effect (95% CI) | Risk with control - placebo | Risk with intervention - Used drug (95% CI) | No of participants (studies) |
|---|---|---|---|---|
| Sevelamer | ||||
| All-cause mortality: Follow-up: 3 to 24 months | RR 2.16 (0.20 to 22.8) | 8 / 1000 | 17 / 1000 (2 to 183) | 248 (3) |
| Mean S-phosphate level: Follow-up: 2 to 10 months | -- | 4.48 mg/dL | 0.28 mg/dL lower (0.39 higher to 0.94 lower) | 483 (5) |
| Lanthanum | ||||
| All-cause mortality: Follow-up: 1.8 to 12 months | RR 1.63 (0.07 to 37.12) | 0 / 1000 | 0 / 1000 | 214 (3) |
| Mean S-phosphate level: Follow-up: 1.8 to 12 months | -- | 4.7 mg/dL | 0.48 mg/dL lower (0.05 to 0.90 lower) | 171 (4) |
| Iron | ||||
| All-cause mortality: Follow-up: 2.75 to 3 months | RR 0.52 (0.06 to 4.65) | 19 per 1000 | 10 per 1000 (1 to 89) | 239 (2) |
| Mean S-phosphate level: Follow-up: 1.8 to 3 months | -- | 5.8 mg/dL | 1.33 mg/dL lower (0.41 to 2.25 lower) | 422 (3) |
| Calcium | ||||
| All-cause mortality | RR 0.46 (0.05 to 4.32) | 47 per 1000 | 22 per 1000 (2 to 203) | 110 (1) |
| Mean S-phosphate level: Follow-up: 5.5 to 24 months | -- | 5.0 mg/dL | 0.18 mg/dL lower (0.95 higher to 1.30 lower) | 151 (3) |
Comment: The quality of evidence is downgraded by risk of bias (several shortcomings in many of the studies).
Primary/Secondary Keywords