title: The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis.
abstract: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD).
  
  
  
  We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD.
  
  
  
  Fifty-one trials (8829 patients) were reviewed. Compared with calcium-based binders, all-cause mortality was nonsignificantly lower with sevelamer {risk ratio [RR] 0.62 [95% confidence interval (CI) 0.35-1.08]} and lanthanum [RR 0.73 (95% CI 0.18-3.00)], but risk of bias was concerning. Compared with calcium-based binders, sevelamer reduced the risk of hypercalcemia [RR 0.27 (95% CI 0.17-0.42)], as did lanthanum [RR 0.12 (95% CI 0.05-0.32)]. Sevelamer reduced hospitalizations [RR 0.50 (95% CI 0.31-0.81)], but not lanthanum [RR 0.80 (95% CI 0.34-1.93)]. The presence/absence of other clinically relevant outcomes was infrequently reported. Compared with calcium-based binders, sevelamer reduced serum calcium, low-density lipoprotein and coronary artery calcification, but increased intact parathyroid hormone. The clinical relevance of these changes is unknown since corresponding clinical outcomes were not reported. Lanthanum had less favorable impact on biochemical parameters. Sevelamer hydrochloride and sevelamer carbonate were similar in three studies. Sevelamer was similar to lanthanum (three studies) and iron-based binders (three studies).
  
  
  
  Sevelamer was associated with a nonsignificant reduction in mortality and significantly lower hospitalization rates and hypercalcemia compared with calcium-based binders. However, differences in important outcomes, such as cardiac events, fractures, calciphylaxis, hyperchloremic acidosis and health-related quality of life remain understudied. Lanthanum and iron-based binders did not show superiority for any clinically relevant outcomes. Future studies that fail to measure clinically important outcomes (the reason why phosphate binders are prescribed in the first place) will be wasteful.
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Habbous
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Przech
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.|London Health Sciences Centre, Division of Nephrology, Western University, London, ON, Canada.
authors.forename: Rey
authors.initials: R
authors.lastname: Acedillo
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
authors.forename: Sisira
authors.initials: S
authors.lastname: Sarma
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.|London Health Sciences Centre, Division of Nephrology, Western University, London, ON, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.|Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Martin
mesh_terms: D015415:Biomarkers / Q000097:blood; D017610:Calcium Compounds / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use*; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D007811:Lanthanum / Q000627:therapeutic use*; D010710:Phosphates / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012449:Safety; D000069603:Sevelamer / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D017610:Calcium Compounds; D002614:Chelating Agents; D010710:Phosphates; D007811:Lanthanum; D000069603:Sevelamer
keywords: chronic kidney disease; hyperphosphatemia; lanthanum; sevelamer; systematic review