The effects of phosphate-lowering therapies on clinical outcomes in patients with CKD were unknown; systematic evaluations had mostly included dialysis patients. For a study, researchers sought to synthesize information from randomized controlled trials (RCTs) regarding the advantages and dangers of non-calcium-based phosphate-lowering medication in nondialysis CKD. In people with CKD who were not on dialysis or post-transplant, they did a comprehensive review and meta-analysis of RCTs comparing non-calcium-based phosphate-lowering treatment to placebo, calcium-based binders, or no study drug. The RCTs were followed up for 3 months, and the outcomes included mineral metabolism biomarkers, cardiovascular measures, and adverse events. The Sidik–Jonkman approach for random effects was used to meta-analyze outcomes. For continuous outcomes with comparable measurement units, unstandardized mean differences were used as effect sizes, whereas Hedge’s g standardized mean differences (SMD) were employed otherwise. For binary outcomes, odds ratios were utilized. The certainty of the evidence was evaluated by the Cochrane risk of bias and GRADE evaluation.
In all, 20 studies with a total of 2,498 individuals were suitable for inclusion (median sample size 120, median follow-up 9 months). The danger of bias was modest overall. Non Calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37; 95% CI, -0.58 to -0.15 mg/dl, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61; 95% CI, -0.90 to -0.31, low certainty evidence), but increased constipation (9 trials, log odds ratio [OR] 0.93; 95% CI, 0.02-1.83, low certainty evidence) and more vascular calcification score (3 trials, SMD, 0.47; 95% CI, 0.17 to 0.77, very low certainty evidence). There was little data on the impact of phosphate-lowering treatment on cardiovascular events (log OR, 0.51; 95% CI, -0.51 to 1.17) and mortality.
Non-Calcium-based phosphate-lowering treatment decreased blood phosphate and urine phosphate excretion, but the effect on clinical outcomes and intermediate cardiovascular end goals was equivocal. To assess the advantages and dangers of phosphate-lowering treatment on patient-centered outcomes, adequately powered RCTs are necessary.
Reference:jasn.asnjournals.org/content/33/1/59
