Effect of Calcium-based Phosphate Binders Versus Sevelamer on Mortality of Patients with Hemodialysis: A Meta-analysis

Area of Science:

• Nephrology
• Public Health
• Clinical Trials

Background:

• Chronic kidney disease (CKD) poses a significant public health challenge.
• Phosphate binders are crucial for managing CKD complications in hemodialysis patients.
• Comparing sevelamer and calcium-based binders is essential for optimizing patient outcomes.

Purpose of the Study:

• To compare the effects of sevelamer versus calcium-based phosphate binders on mortality in hemodialysis patients.
• To evaluate the impact of these binders on cardiovascular and all-cause mortality.
• To assess differences in calcium and phosphorus levels between the two binder types.

Main Methods:

• A systematic literature search was conducted on PubMed, EMBASE, and Web of Science before May 14, 2020.
• Six studies involving 43,330 hemodialysis patients were included in the meta-analysis.
• Analysis compared outcomes between patients receiving calcium-based phosphate binders and sevelamer.

Main Results:

• Unadjusted data suggested sevelamer might lower cardiovascular mortality.
• Adjusted analyses revealed no significant difference in cardiovascular mortality between sevelamer and calcium-based binders.
• No significant difference in all-cause mortality was observed between the groups after adjusting for confounders, despite initial differing rates.

Conclusions:

• Sevelamer and calcium-based phosphate binders demonstrate comparable effects on all-cause mortality risk in hemodialysis patients.
• The study highlights inconsistencies in sensitivity analyses, indicating potential instability in the findings.
• High-quality, large-scale randomized controlled trials are recommended to definitively confirm these results.