Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis

被引：406

作者：

Jamal, Sophie A. ^{[1
,2
]}

Vandermeer, Ben ^{[6
]}

Raggi, Paolo ^{[7
]}

Mendelssohn, David C. ^{[5
,10
]}

Chatterley, Trish ^{[8
]}

Dorgan, Marlene ^{[8
]}

Lok, Charmaine E. ^{[3
]}

Fitchett, David ^{[4
]}

Tsuyuki, Ross T. ^{[9
]}

机构：

[1] Univ Toronto, Womens Coll Hosp, Div Endocrinol & Metab, Toronto, ON, Canada

[2] Univ Toronto, St Michaels Hosp, Womens Coll Res Inst, Toronto, ON, Canada

[3] Univ Toronto, St Michaels Hosp, Div Nephrol, Toronto, ON, Canada

[4] Univ Toronto, St Michaels Hosp, Div Cardiol, Toronto, ON, Canada

[5] Univ Toronto, Toronto, ON, Canada

[6] Univ Alberta, Alberta Res Ctr Hlth Evidence, Dept Pediat, Edmonton, AB, Canada

[7] Univ Alberta, Walter C Mackenzie Hlth Sci Ctr, Mazankowski Alberta Heart Inst, Edmonton, AB, Canada

[8] Univ Alberta, Walter C Mackenzie Hlth Sci Ctr, John W Scott Hlth Sci Lib, Edmonton, AB, Canada

[9] Univ Alberta, Div Cardiol, Edmonton, AB, Canada

[10] Humber River Reg Hosp, Dept Nephrol, Toronto, ON, Canada

来源：

LANCET | 2013年 / 382卷 / 9900期

关键词：

CORONARY-ARTERY CALCIFICATION; HEMODIALYSIS-PATIENTS; AORTIC CALCIFICATION; RENAL-DISEASE; SEVELAMER; CARBONATE; PROGRESSION; IMPACT; PHOSPHORUS; METABOLISM;

D O I：

10.1016/S0140-6736(13)60897-1

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Background Phosphate binders (calcium-based and calcium-free) are recommended to lower serum phosphate and prevent hyperphosphataemia in patients with chronic kidney disease, but their effects on mortality and cardiovascular outcomes are unknown. We aimed to update our meta-analysis on the effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease. Methods We did a systematic review of articles published in any language after Aug 1, 2008, up until Oct 22, 2012, by searching Medline, Embase, International Pharmaceutical Abstracts, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature. We included all randomised and non-randomised trials that compared outcomes between patients with chronic kidney disease taking calcium-based phosphate binders with those taking non-calcium-based binders. Eligible studies, determined by consensus with predefined criteria, were reviewed, and data were extracted onto a standard form. We combined data from randomised trials to assess the primary outcome of all-cause mortality using the DerSimonian and Laird random effects model. Findings Our search identified 847 reports, of which eight new studies (five randomised trials) met our inclusion criteria and were added to the ten (nine randomised trials) included in our previous meta-analysis. Analysis of the 11 randomised trials (4622 patients) that reported an outcome of mortality showed that patients assigned to non-calcium-based binders had a 22% reduction in all-cause mortality compared with those assigned to calcium-based phosphate binders (risk ratio 0.78, 95% CI 0.61-0.98). Interpretation Non-calcium-based phosphate binders are associated with a decreased risk of all-cause mortality compared with calcium-based phosphate binders in patients with chronic kidney disease. Further studies are needed to identify causes of mortality and to assess whether mortality differs by type of non-calcium-based phosphate binder.

引用

页码：1268 / 1277

页数：10

共 33 条

[1]

[Anonymous], AM SCHOLAR

[2]

Phosphate Binder Impact on Bone Remodeling and Coronary Calcification - Results from the BRiC Study [J].