title: Calcium acetate or calcium carbonate for hyperphosphatemia of hemodialysis patients: a meta-analysis.
abstract: BACKGROUND
  High levels of serum phosphorus both at baseline and during follow-up are associated with increased mortality in dialysis patients, and administration of phosphate binders was independently associated with improved survival among hemodialysis population. Calcium-based phosphate binders are the most commonly used phosphate binders in developing countries for their relatively low costs.
  
  
  OBJECTIVE
  To compare the efficacy and safety between calcium carbonate and calcium acetate in the treatment of hyperphosphatemia in hemodialysis patients.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library, Google scholar and Chinese databases (Wanfang, Weipu, National Knowledge Infrastructure of China) were searched for relevant studies published before March 2014. Reference lists of nephrology textbooks and review articles were checked. A meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs that assessed the effects and adverse events of calcium acetate and calcium carbonate in adult patients with MHD was performed using Review Manager 5.0.
  
  
  RESULTS
  A total of ten studies (625 participants) were included in this meta-analysis. There was insufficient data in all-cause mortality and cardiovascular events for meta-analysis. Compared with calcium carbonate group, the serum phosphorus was significantly lower in calcium acetate group after4 weeks' administration (MD -0.15 mmol/L, 95% CI -0.28 to -0.01) and after 8 weeks' administration (MD -0.25 mmol/L, 95% CI -0.40 to -0.11). There was no difference in serum calcium levels or the incidence of hypercalcemia between two groups at 4 weeks and 8 weeks. No statistical difference was found in parathyroid hormone (PTH) levels or serum calcium by phosphorus (Ca x P) product. There was significantly higher risk of intolerance with calcium acetate treatment (RR 3.46, 95% CI 1.48 to 8.26).
  
  
  CONCLUSIONS
  For hyperphosphatemia treatment, calcium acetate showed better efficacy and with a higher incidence of intolerance compared with calcium carbonate. There are insufficient data to establish the comparative superiority of the two calcium-based phosphate binders on all-cause mortality and cardiovascular end-points in hemodialysis patients.
authors: Division of Hemodialysis, CPLA 422 Hospital, Guangdong, China.
authors: Yong
authors: Y
authors: Wang
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Guoqiang
authors: G
authors: Xie
authors: Division of Nephrology, General Hospital of Guangzhou Military Region, Guangdong, China.
authors: Yuanhang
authors: Y
authors: Huang
authors: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Han
authors: H
authors: Zhang
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Bo
authors: B
authors: Yang
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Zhiguo
authors: Z
authors: Mao
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D002119:Calcium Carbonate / Q000008:administration & dosage / Q000009:adverse effects*; D017610:Calcium Compounds / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D002119:Calcium Carbonate; C120662:calcium acetate