title: Effectiveness and cost-efficacy of phosphate binders in hemodialysis.
abstract: OBJECTIVE
  Worldwide, incidence rates of chronic renal insufficiency have clearly increased over the past decade, especially in people of older age. Hyperphosphatemia is the strongest independent risk factor for mortality in renal patients. In order to reduce serum phosphate concentrations to recommended values, phosphate binders (P binders) are used to bind ingested phosphate in the digestive tract. Besides the traditional therapies with calcium and aluminium salts, sevelamer and lanthanum represent recent developments on the market. The purpose of the present health technology assessment (HTA) report was to compare the effectiveness and safety of different P binders in patients with chronic renal insufficiency.
  
  
  METHODS
  Based on a systematic literature search followed by a two-part selection process with predefined criteria 18 publications were included in the assessment.
  
  
  RESULTS
  All P binders effectively controlled serum phosphate, calcium and parathyroid hormone concentrations. The numbers of hypercalcemic episodes were higher when using calcium-containing P binders compared to sevelamer and lanthanum. Regarding mortality rate, cardiovascular calcification and bone metabolism no definite conclusions could be drawn; however, sevelamer seemed to be more effective than calcium in certain patient subgroups, such as older patients and patients with preexisting arterial calcification.
  
  
  CONCLUSIONS
  From a medical point of view, sevelamer showed superiority over calcium-containing P binders at least for special indications.
authors: Gesundheit Österreich GmbH, Vienna, Austria. sophie.brunner@goeg.at
authors: Sophie
authors: S
authors: Brunner-Ziegler
authors: Barbara
authors: B
authors: Fröschl
authors: Cora
authors: C
authors: Hiebinger
authors: Johannes
authors: J
authors: Zsifkovits
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000009:adverse effects / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000517:prevention & control; D017046:Cost Savings; D017048:Health Care Costs; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000517:prevention & control; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000517:prevention & control; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control; D007811:Lanthanum / Q000009:adverse effects / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood / Q000737:chemistry*; D011073:Polyamines / Q000009:adverse effects / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D000069603:Sevelamer; D013673:Technology Assessment, Biomedical
chemical_list: D002614:Chelating Agents; D015312:Hemodialysis Solutions; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011073:Polyamines; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002118:Calcium