Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China.
Outpatient Department, Xi'an Children's Hospital, Xi'an, China.
Ren Fail. 2021 Dec;43(1):1378-1393. doi: 10.1080/0886022X.2021.1986068.
The aim of this study was to determine the efficacy and safety of lanthanum carbonate (LC) versus calcium salts, non-LC phosphate binders (PBs), sevelamer, or placebo in patients with chronic kidney disease (CKD).
A literature search on PubMed, Embase, and Cochrane Library databases was conducted up to 18 June 2021. Data acquisition and quality assessment were performed by two reviewers. Meta-analysis was performed to evaluate the serum biochemical parameters, adverse events, and patient-level outcomes of LC, non-LC PBs, and sevelamer for hyperphosphatemia in patients with CKD. Heterogeneity across studies was assessed utilizing the statistic and -test, and a random effect model was selected to calculate the pooled effect size.
A total of 26 randomized, controlled trials and 3 observational studies were included. Compared to the other groups, better control effect of serum phosphorus (RR = 2.68, < 0.001), reduction in serum phosphorus (95%CI = -1.93, -0.99; < 0.001), Ca × P (95%CI = -13.89, -2.99; = 0.002), serum intact parathyroid hormone levels (95%CI = -181.17, -3.96, = 0.041) were found in LC group. Besides, reduced risk of various adverse effects, such as hypotension, abdominal pain, diarrhea, dyspepsia, and a score of coronary artery calcification were identified with LC in comparison to calcium salt, non-LC PBs, or placebo group. Significantly lower risk in mortality with LC treatment vs. non-LC PBs was observed, while no significant difference was identified between LC and calcium salt groups.
LC might be an alternative treatment for hyperphosphatemia in patients with CKD considering its comprehensive curative effect.
本研究旨在评估碳酸钙（LC）与钙盐、非 LC 磷结合剂（PBs）、司维拉姆或安慰剂在慢性肾脏病（CKD）患者中的疗效和安全性。
对 PubMed、Embase 和 Cochrane 图书馆数据库进行文献检索，检索时间截至 2021 年 6 月 18 日。由两名评审员进行数据采集和质量评估。采用 Meta 分析评估 LC、非 LC PBs 和司维拉姆治疗 CKD 患者高磷血症的血清生化参数、不良反应和患者结局。采用 Q 检验和 I ² 检验评估研究间的异质性，选择随机效应模型计算合并效应量。
共纳入 26 项随机对照试验和 3 项观察性研究。与其他组相比，LC 组血清磷的控制效果更好（RR=2.68，<0.001），血清磷降低（95%CI=-1.93，-0.99；<0.001），Ca×P 降低（95%CI=-13.89，-2.99；=0.002），血清全段甲状旁腺激素水平降低（95%CI=-181.17，-3.96，=0.041）。与钙盐、非 LC PBs 或安慰剂组相比，LC 组不良反应的风险降低，如低血压、腹痛、腹泻、消化不良和冠状动脉钙化评分。LC 组与非 LC PBs 组相比，死亡率的风险显著降低，而 LC 组与钙盐组相比无显著差异。
鉴于 LC 的综合疗效，LC 可能是治疗 CKD 患者高磷血症的一种替代治疗方法。
