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The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic

Sophie A Jamal1, David Fitchett, Charmaine E Lok

  • 1University of Toronto, Division of Endocrinology and Metabolism, Women's College Hospital, Toronto, Canada.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|July 23, 2009
PubMed

Insights

Non-calcium phosphate binders showed a trend toward lower mortality in chronic kidney disease patients. However, significant differences in cardiovascular events or vascular calcification were not found, necessitating further research.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • The comparative effects of calcium-based versus non-calcium-based phosphate binders on patient outcomes in chronic kidney disease (CKD) remain unclear.
  • Key outcomes of interest include mortality, cardiovascular events, and vascular calcification.

Purpose of the Study:

  • To systematically review and analyze the available evidence comparing calcium-based and non-calcium-based phosphate binders in CKD patients.
  • To assess the impact of these binders on mortality, cardiovascular events, and vascular calcification.

Main Methods:

  • A systematic review was performed using electronic searches of major biomedical databases (MEDLINE, EMBASE, Cochrane, CINAHL).
  • Included were 8 randomized trials involving 2873 patients, identified through predefined criteria.
  • Data extraction and analysis were conducted systematically.

Main Results:

  • A trend towards decreased all-cause mortality was observed with non-calcium-based binders (RR 0.68; 95% CI 0.41-1.11).
  • No statistically significant difference was found for cardiovascular events (RR 0.85; 95% CI 0.35-2.03).
  • Analysis of coronary artery calcification showed a non-significant trend favoring non-calcium-based binders (change in calcium score: -76.35; 95% CI -158.25-5.55).

Conclusions:

  • While trends suggest potential benefits of non-calcium-based phosphate binders, statistically significant differences were not established for mortality, cardiovascular events, or coronary artery calcification.
  • The current evidence is limited by the small number of studies and sample sizes.
  • Further randomized trials are warranted to definitively assess the comparative efficacy and safety of these agents.
Abstract

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