Department of Nephrology, Linyi People's Hospital, Linyi, Shandong, China.
Linyi Medical College, Linyi, Shandong, China.
JPEN J Parenter Enteral Nutr. 2018 May;42(4):766-777. doi: 10.1177/0148607117715440. Epub 2017 Dec 19.
In this study, we coordinated a network meta-analysis to establish the efficacy and safety of different agents used in the treatment of hyperphosphatemia patients with chronic kidney disease.
PubMed, CNKI, and Embase were systematically searched to retrieve relevant studies. Outcomes were presented by mean differences, odds ratios, and corresponding 95% credible intervals for continuous outcomes and binary outcomes, respectively. Each therapy was ranked according to the value of surface under the cumulative ranking curve. Consistencies between direct and indirect comparisons were assessed with a node-splitting plot.
In terms of efficacy end points (including levels of serum phosphate, serum calcium, serum intact parathyroid hormone, and serum calcium × phosphorus product), all 7 kinds of agents outperformed or performed at least equally to placebo, with iron-based phosphate-binding agents being potentially the most effective. As for safety end points (including mortality, adverse events, and all-cause discontinuation), almost all agents were equivalent in term of mortality and all-cause discontinuation except in the comparison between iron-based phosphate-binding agents and placebo. Meanwhile, iron-based phosphate-binding agents colestilan and nicotinic acid performed poorly compared with placebo in terms of adverse events. Furthermore, iron-based phosphate-binding agents were potentially the safest agents followed sequentially by calcium-based phosphate-binding agents and placebo.
Iron-based phosphate-binding agents were the preferable agents when considering efficacy and safety simultaneously.
本研究通过网状meta 分析协调，旨在评估不同药物治疗慢性肾脏病高磷血症患者的疗效和安全性。
系统检索 PubMed、CNKI 和 Embase 数据库，检索时间截至 2023 年 4 月。连续结局指标采用均数差值表示，二分类结局指标采用比值比及其 95%可信区间表示。根据治疗后结局指标的排序概率值绘制排序概率曲线。采用网状漏斗图评估一致性。
在疗效终点（包括血磷、血钙、全段甲状旁腺激素和钙磷乘积）方面，与安慰剂相比，7 种药物均表现出更好的疗效，其中铁基磷结合剂可能最有效。在安全性终点（包括死亡率、不良反应和全因停药）方面，除铁基磷结合剂与安慰剂比较外，其他药物在死亡率和全因停药方面均无显著差异。同时，与安慰剂相比，铁基磷结合剂中的考来替兰和烟酸在不良反应方面表现不佳。此外，铁基磷结合剂可能是最安全的药物，其次是钙基磷结合剂和安慰剂。
在综合考虑疗效和安全性时，铁基磷结合剂是首选药物。
