A Cochrane review «Phosphate binders for preventing and treating chronic kidney disease‐mineral and bone disorder (CKD‐MBD)»1 «Ruospo M, Palmer SC, Natale P et al. Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD). Cochrane Database Syst Rev 2018;(8):CD006023. »1 included 104 studies with a total of 13 744 subjects. Phosphate binders are widely used to slow the development and progression mineral and bone disorder in chronic kidney disease (CKD). In CKD grade 2 to 5, compared with placebo or usual care, sevelamer, lanthanum, iron and calcium-based phosphate binders had uncertain or inestimable effects on death (all causes), cardiovascular death, myocardial infarction, stroke, fracture, or coronary artery calcification (table « Phosphate binders versus placebo/usual care for chronic kidney disease-mineral and bone disorder »1). They reduced serum phosphorus levels compared to placebo.
| Outcome | Relative effect (95% CI) | Risk with control - placebo | Risk with intervention - Used drug (95% CI) | No of participants (studies) |
|---|---|---|---|---|
| Sevelamer | ||||
| All-cause mortality: Follow-up: 3 to 24 months | RR 2.16 (0.20 to 22.8) | 8 / 1000 | 17 / 1000 (2 to 183) | 248 (3) |
| Mean S-phosphate level: Follow-up: 2 to 10 months | -- | 4.48 mg/dL | 0.28 mg/dL lower (0.39 higher to 0.94 lower) | 483 (5) |
| Lanthanum | ||||
| All-cause mortality: Follow-up: 1.8 to 12 months | RR 1.63 (0.07 to 37.12) | 0 / 1000 | 0 / 1000 | 214 (3) |
| Mean S-phosphate level: Follow-up: 1.8 to 12 months | -- | 4.7 mg/dL | 0.48 mg/dL lower (0.05 to 0.90 lower) | 171 (4) |
| Iron | ||||
| All-cause mortality: Follow-up: 2.75 to 3 months | RR 0.52 (0.06 to 4.65) | 19 per 1000 | 10 per 1000 (1 to 89) | 239 (2) |
| Mean S-phosphate level: Follow-up: 1.8 to 3 months | -- | 5.8 mg/dL | 1.33 mg/dL lower (0.41 to 2.25 lower) | 422 (3) |
| Calcium | ||||
| All-cause mortality | RR 0.46 (0.05 to 4.32) | 47 per 1000 | 22 per 1000 (2 to 203) | 110 (1) |
| Mean S-phosphate level: Follow-up: 5.5 to 24 months | -- | 5.0 mg/dL | 0.18 mg/dL lower (0.95 higher to 1.30 lower) | 151 (3) |
Comment: The quality of evidence is downgraded by risk of bias (several shortcomings in many of the studies).