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Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney

Sophie A Jamal1, Ben Vandermeer, Paolo Raggi

  • 1Division of Endocrinology and Metabolism, Women's College Hospital, University of Toronto, Toronto, ON, Canada. sophie.jamal@utoronto.ca

Lancet (London, England)
|July 23, 2013
PubMed

Insights

Non-calcium-based phosphate binders significantly reduce all-cause mortality in chronic kidney disease patients compared to calcium-based binders. This meta-analysis confirms a 22% reduction in mortality risk for non-calcium-based options.

Area of Science:

  • Nephrology
  • Pharmacology
  • Clinical Trials

Background:

  • Phosphate binders are crucial for managing hyperphosphatemia in chronic kidney disease (CKD).
  • The comparative effects of calcium-based versus calcium-free phosphate binders on mortality and cardiovascular outcomes in CKD patients remain unclear.
  • This study aimed to update a meta-analysis on the mortality impact of calcium-based versus non-calcium-based phosphate binders in CKD.

Purpose of the Study:

  • To compare the efficacy of calcium-based versus non-calcium-based phosphate binders in reducing all-cause mortality in CKD patients.
  • To update existing meta-analysis findings with recent study data.

Main Methods:

  • Systematic review of randomized and non-randomized trials published between August 2008 and October 2012.
  • Searched multiple databases including Medline, Embase, and Cochrane Central.
  • Data from 11 randomized trials involving 4622 CKD patients were analyzed for all-cause mortality using a random effects model.

Main Results:

  • Eight new studies were added to a previous meta-analysis, totaling 11 randomized trials.
  • Non-calcium-based phosphate binders demonstrated a 22% reduction in all-cause mortality compared to calcium-based binders (Risk Ratio: 0.78, 95% CI: 0.61-0.98).

Conclusions:

  • Non-calcium-based phosphate binders are associated with a lower risk of all-cause mortality in CKD patients.
  • Further research is warranted to explore specific causes of mortality and differences among non-calcium-based binder types.
Abstract

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