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Evidence summaries

Phosphate Binders in Chronic Kidney Disease

Phosphate binders (calcium-based agents, sevelamer, lanthanum) may reduce serum phosphorus levels in chronic kidney disease compared with placebo. However, their use may not be effective for reducing all-cause mortality. Level of evidence: "C"

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.

Phosphate binders versus placebo/usual care for chronic kidney disease-mineral and bone disorder

OutcomeRelative effect (95% CI)Risk with control - placeboRisk with intervention - Used drug (95% CI)No of participants (studies)
Sevelamer
All-cause mortality: Follow-up: 3 to 24 monthsRR 2.16 (0.20 to 22.8)8 / 100017 / 1000 (2 to 183)248 (3)
Mean S-phosphate level: Follow-up: 2 to 10 months--4.48 mg/dL0.28 mg/dL lower (0.39 higher to 0.94 lower)483 (5)
Lanthanum
All-cause mortality: Follow-up: 1.8 to 12 monthsRR 1.63 (0.07 to 37.12)0 / 10000 / 1000214 (3)
Mean S-phosphate level: Follow-up: 1.8 to 12 months--4.7 mg/dL0.48 mg/dL lower (0.05 to 0.90 lower)171 (4)
Iron
All-cause mortality: Follow-up: 2.75 to 3 monthsRR 0.52 (0.06 to 4.65)19 per 100010 per 1000 (1 to 89)239 (2)
Mean S-phosphate level: Follow-up: 1.8 to 3 months--5.8 mg/dL1.33 mg/dL lower (0.41 to 2.25 lower)422 (3)
Calcium
All-cause mortalityRR 0.46 (0.05 to 4.32)47 per 100022 per 1000 (2 to 203)110 (1)
Mean S-phosphate level: Follow-up: 5.5 to 24 months--5.0 mg/dL0.18 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).

    References

    • Ruospo M, Palmer SC, Natale P et al. Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD). Cochrane Database Syst Rev 2018;(8):CD006023. [PubMed]

Primary/Secondary Keywords