title: Effects and safety of iron-based phosphate binders in dialysis patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the effects and safety of iron-based phosphate binders in adult patients receiving dialysis.
  
  
  METHODS
  We electronically searched MEDLINE, EMBASE, CENTRAL, and CBM for randomized controlled trials about iron-based phosphate binders in adult dialysis patients. Study quality was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of intervention. Meta-analysis was conducted by RevMan 5.3.
  
  
  RESULTS
  Eight studies with 2018 participants were eligible for our meta-analysis. Iron-based phosphate binders were superior to placebo (MD = -2.43 mg/dL, 95% CI: -3.18 to -1.68, p < 0.00001) and as efficient as sevelamer (MD = 0.04 mg/dL, 95% CI: -0.29 to 0.36, p = 0.83) in reducing serum phosphorus in dialysis patients. No significant differences were found in all adverse events (OR = 1.30, 95% CI: 0.77 to 2.20, p = 0.32) between iron-based phosphate binders and placebo. Iron-based phosphate binders were associated with significant higher serum iron (MD = 9.39 ng/mL, 95% CI 1.48 to 17.30, p = 0.02), higher serum transferring saturation (MD = 6.29%, 95% CI 2.72 to 9.87, p = 0.0006) and lower serum total iron binding capacity (MD = -23.13 µg/dL, 95% CI -35.69 to -10.58, p = 0.0003) in comparison to placebo.
  
  
  CONCLUSIONS
  Iron-based phosphate binders are as effective as sevelamer and well tolerated for hyperphosphatemia in dialysis patients. Iron-based phosphate binders appear to have a beneficial effect on renal anemia in patients receiving dialysis. Therefore, iron-based phosphate binders may represent a new treatment option for dialysis patients.
authors.affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University , Jinan, Shandong , China .
authors.forename: Chun-Juan
authors.initials: CJ
authors.lastname: Zhai
authors.forename: Xin-Shuang
authors.initials: XS
authors.lastname: Yu
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
mesh_terms: D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D007501:Iron / Q000494:pharmacology; D010710:Phosphates / Q000378:metabolism*; D011073:Polyamines / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects*; D064449:Sequestering Agents / Q000494:pharmacology*; D000069603:Sevelamer
chemical_list: D010710:Phosphates; D011073:Polyamines; D064449:Sequestering Agents; D000069603:Sevelamer; D007501:Iron
keywords: Dialysis; hyperphosphatemia; iron; meta-analysis; phosphate binders; systematic review