title: New Conclusions Regarding Comparison of Sevelamer and Calcium-Based Phosphate Binders in Coronary-Artery Calcification for Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Sevelamer hydrochloride is used widely, but its impact upon cardiovascular calcification, cardiovascular mortality, all-cause mortality and hospitalization is not known.
  
  
  RESULTS
  Primary outcome was cardiovascular calcification (coronary artery calcification scores (CACS) and aortic calcification scores (ACS)). Secondary outcomes were serum characteristics, hospitalization, cardiovascular mortality and all-cause mortality. Risk ratio (RR), mean differences and standard mean difference with 95% confidence intervals (CIs) were pooled using random- or fixed-effects models.
  
  
  RESULTS
  We identified 31 studies (on 23 randomized controlled trials with 4395 participants). An analysis pooling showed a significant decrease in serum levels of phosphate with calcium-based phosphate binders (CBPBs) by 0.17 mg/dL [mean difference (MD), 95% CI, 0.03, 0.31] than sevelamer. A significant difference in the change of CACS by -102.66 [MD: 95% CI, -159.51, -45.80] and ACS by -1008.73 [MD, 95% CI, -1664.75, -352.72] between sevelamer and CBPBs was observed. Prevalence of hypercalcemia (serum levels of calcium >10.2-10.5 mg/dL and >11.0 mg/dL) was significantly smaller for sevelamer (RR = 0.44, 95% CI, 0.33, 0.58; RR = 0.24, 95% CI, 0.14, 0.40). No significant difference was found in hospitalization, all-cause mortality or cardiovascular mortality.
  
  
  CONCLUSIONS
  This meta-analysis suggests that sevelamer benefits dialysis patients in terms of CACS, ACS and hypercalcemia.
authors.affiliation: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Nephrology, The Affiliated Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China.
authors.forename: Yongming
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Shaomin
authors.initials: S
authors.lastname: Li
authors.affiliation: Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, China.
authors.forename: Yanbing
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Tanqi
authors.initials: T
authors.lastname: Lou
mesh_terms: D002114:Calcinosis; D002130:Calcium Phosphates; D003331:Coronary Vessels / Q000473:pathology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D000069603:Sevelamer
chemical_list: D002130:Calcium Phosphates; D000069603:Sevelamer