The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis.
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).


CONCLUSIONS
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.
Jamal
Sophie A
SA
University of Toronto, Division of Endocrinology and Metabolism, Women's College Hospital, Toronto, Canada.
Fitchett
David
D
Lok
Charmaine E
CE
Mendelssohn
David C
DC
Tsuyuki
Ross T
RT
D000085:Acetates / Q000627:therapeutic use*; D002119:Calcium Carbonate / Q000627:therapeutic use*; D017610:Calcium Compounds / Q000627:therapeutic use; D002423:Cause of Death; D002614:Chelating Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D007811:Lanthanum / Q000627:therapeutic use*; D011073:Polyamines / Q000627:therapeutic use*; D000069603:Sevelamer
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; D007811:Lanthanum; D000069603:Sevelamer; D002119:Calcium Carbonate; C120662:calcium acetate