NDT Advance Access originally published online on July 21, 2009
Nephrology Dialysis Transplantation 2009 24(10):3168-3174; doi:10.1093/ndt/gfp350
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The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis
1 University of Toronto and Multidisciplinary Osteoporosis Program, Division of Endocrinology and Metabolism, Women's College Hospital 2 Division of Cardiology, St. Michael's Hospital 3 Division of Nephrology, University of Toronto, University Health Network 4 Department of Nephrology, University of Toronto and Chief, Humber River Regional Hospital 5 Division of Cardiology, EPICORE Centre, University of Alberta, Canada
Correspondence and offprint requests to: Ross T. Tsuyuki; E-mail: ross.tsuyuki{at}ualberta.ca
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Abstract |
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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 0.41–1.11] based upon eight randomized controlled trials and 2873 subjects. Two trials reported on cardiovascular events with a RR of 0.85 (95% CI 0.35–2.03) 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 –158.25–5.55).
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.
Keywords: chronic kidney disease; meta-analysis; phosphate binders; systematic review; vascular calcification
Received for publication: 3. 3.09
Accepted in revised form: 25. 6.09
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