The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis
Authors: Jamal, Sophie A.; Fitchett, David; Lok, Charmaine E.; Mendelssohn, David C.; Tsuyuki, Ross T.
Source: Nephrology Dialysis Transplantation, Volume 24, Number 10, 10 October 2009 , pp. 3168-3174(7)
Publisher: Oxford University Press
Abstract:Background. The effects of calcium compared with non-calcium-based phosphate binders on mortality, cardiovascular events and vascular calcification in patients with chronic kidney disease (CKD) are unknown.
Methods. To address this question, we conducted a systematic review. We electronically searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL. We identified 160 potential studies and included 8 randomized trials. Eligible studies, determined by consensus using predefined criteria, were reviewed, and data were extracted onto a standard from.
Results. There was a trend towards a decrease in all-cause mortality among non-calcium-based versus calcium-based phosphate binders relative risk (RR) 0.68; 95 CI 0.411.11 based upon eight randomized controlled trials and 2873 subjects. Two trials reported on cardiovascular events with a RR of 0.85 (95 CI 0.352.03) in patients receiving calcium-based versus non-calcium-based binders. Coronary artery calcification was reported in five trials involving 469 patients; the difference in the change in the calcium score from baseline to follow-up among subjects taking non-calcium-based binders versus calcium-based binders was 76.35 (95 CI 158.255.55).
Conclusion. Despite the trends observed, we did not find a statistically significant difference in cardiovascular mortality and coronary artery calcification in patients receiving calcium-based phosphate binders compared to non-calcium-based phosphate binders. However, the data are limited by the small number of studies and the confidence intervals do not exclude a potentially important beneficial effect. Therefore, further randomized trials are required.
Document Type: Research Article
Publication date: 2009-10-10
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