Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 RAMA IV, Bangkok, 10330, Thailand.
Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Nephrol. 2022 Mar;35(2):473-491. doi: 10.1007/s40620-021-01065-3. Epub 2021 Jun 1.
Besides reducing hyperphosphatemia in chronic kidney disease (CKD) patients, phosphate lowering agents might provide beneficial effects on clinical and laboratory parameters. This meta-analysis was conducted to comprehensively examine the impact of all phosphate lowering agents on various aspects of clinical and laboratory outcomes in CKD patients.
A systematic literature search was performed in MEDLINE, Scopus, and the Cochrane Register of Controlled Trials until July 2020 to identify randomized controlled trials (RCTs) which compared the effects of each phosphate lowering agent with controls, comprising placebo and all other phosphate lowering agents. Various clinical and laboratory outcomes were analyzed. Random effects model was used to compute the standardized mean difference for continuous variables and the risk ratio (RR) for binary variables.
This meta-analysis included 127 RCTs with 20,215 patients. Sevelamer and lanthanum significantly reduced all-cause mortality (RR 0.610, 95% CI 0.401-0.929 and 0.467, 95% CI 0.337-0.647, respectively) but not cardiovascular (CV) mortality or CV events. Hospitalization rates were significantly diminished by sevelamer (RR 0.527; 95% CI 0.308-0.902). Certain phosphate lowering agents improved biochemical parameters including serum phosphate, calcium, coronary artery calcium scores, fibroblast growth factor-23, bone biomarkers, and lipid profiles. Intact parathyroid hormone and bone mineral density were not significantly changed.
In addition to decreasing serum phosphate levels, various beneficial effects on clinical and laboratory parameters of phosphate lowering agents might play potential roles in diminishing morbidity and mortality in CKD patients.
除了降低慢性肾脏病（CKD）患者的高磷血症外，降磷药物可能对临床和实验室参数有有益影响。本荟萃分析旨在全面检查所有降磷药物对 CKD 患者临床和实验室结局各个方面的影响。
系统检索 MEDLINE、Scopus 和 Cochrane 对照试验注册库，以确定截至 2020 年 7 月比较每种降磷药物与对照组（安慰剂和其他所有降磷药物）疗效的随机对照试验（RCT）。分析了各种临床和实验室结局。使用随机效应模型计算连续变量的标准化均数差和二分类变量的风险比（RR）。
本荟萃分析纳入了 127 项 RCT，共 20215 例患者。司维拉姆和镧显著降低全因死亡率（RR 0.610，95%CI 0.401-0.929 和 0.467，95%CI 0.337-0.647），但不降低心血管（CV）死亡率或 CV 事件。司维拉姆显著降低住院率（RR 0.527；95%CI 0.308-0.902）。某些降磷药物改善了生化参数，包括血清磷、钙、冠状动脉钙评分、成纤维细胞生长因子-23、骨生物标志物和血脂谱。全段甲状旁腺激素和骨密度无显著变化。
除了降低血清磷水平外，降磷药物对临床和实验室参数的有益影响可能在降低 CKD 患者的发病率和死亡率方面发挥潜在作用。
