title: The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials.
abstract: BACKGROUND
  Vascular calcification significantly increases the rates of cardiovascular mortality in hemodialysis (HD) patients. Abnormalities in mineral metabolism may play a role in the pathogenesis of arterial calcification. Whether patients treated with non-calcium-based phosphate binders had reduced aortic vascular calcification compared to those treated with calcium-based phosphate binders is still unclear.
  
  
  METHODS
  We searched multiple databases for studies published through August 2013 that evaluated the effects of non-calcium-based phosphate binders (NCBP) versus calcium-based phosphate binders (CBP) on cardiovascular calcification and bone remodeling among dialysis patients. We summarized test performance characteristics with the use of forest plots, fixed and random effects models, and Egger regression test.
  
  
  RESULTS
  Eighteen eligible randomized controlled trials totaling 3676 patients were included. Meta-analysis results showed NCBP could significantly attenuate the progression of coronary artery calcification than CBP (WMD: -144.62, 95% CI: -285.62 to -3.63). The serum calcium levels significant lower in NCPB group than in CPB groups (WMD: -0.26, 95% CI: -0.37 to -0.14), but the serum iPTH levels were significantly higher in NCPB groups (WMD: 57.1, 95% CI: 13.42 to 100.78). The osteoid volume and osteoblast numbers were significant higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers). The Egger regression test also showed no potential publication bias (p = 0.725).
  
  
  CONCLUSIONS
  Based on available data, NCBPs have equally effective with CBPs for serum phosphate control. But there was significantly lower incidence of coronary artery calcification and a significant higher bone formatting rate in NCBP groups than in CBP groups. So we recommend NCBPs as phosphate binders for HD patients.
authors.affiliation: Department of Nephrology, Hangzhou Traditional Chinese Medical Hospital , Hangzhou, Zhejiang , China.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
authors.forename: Hongyu
authors.initials: H
authors.lastname: Chen
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Zhu
authors.forename: Liusha
authors.initials: L
authors.lastname: Zhou
authors.forename: Yazhen
authors.initials: Y
authors.lastname: Yang
mesh_terms: D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium; D002130:Calcium Phosphates / Q000494:pharmacology* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D002614:Chelating Agents / Q000627:therapeutic use*; D006801:Humans; D007811:Lanthanum / Q000494:pharmacology* / Q000627:therapeutic use*; D011073:Polyamines / Q000494:pharmacology* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D000069603:Sevelamer; D061205:Vascular Calcification / Q000097:blood / Q000517:prevention & control*
chemical_list: D015415:Biomarkers; D002130:Calcium Phosphates; D002614:Chelating Agents; D011073:Polyamines; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002118:Calcium
keywords: Bone remodeling; calcium-based phosphate binders; cardiovascular calcification; dialysis; meta-analysis; non-calcium-based phosphate binders