Fang Hui, Chen Chunyan
Hemodialysis Center, The Second People's Hospital of Jiashan County Jiaxing 314121, Zhejiang, China.
Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine Jiaxing 314000, Zhejiang, China.
Am J Transl Res. 2024 Nov 15;16(11):6980-6990. doi: 10.62347/WXBL2590. eCollection 2024.
To comprehensively investigate the efficacy and safety of lanthanum carbonate in conjugation with calcium carbonate combination in hemodialysis patients with hyperphosphatemia via a meta-analysis of randomized controlled trials (RCTs).
We conducted a literature search in databases of PubMed, Embase, and Web of Science for RCTs investigating the effect of lanthanum carbonate in combination with calcium carbonate for treating hyperphosphatemia in hemodialysis patients. The search covered all studies from the inception of the database until October 2023. Data extraction and quality assessment were performed on eligible studies, followed by a meta-analysis using RevMan5.3 software.
Ten studies fulfilling the inclusion criteria were included, with a sample size of 475 patients (256 in the experimental group who received lanthanum carbonate and calcium carbonate; 219 in the control group who received calcium carbonate alone). The experimental group showed a significantly higher clinical response rate compared to the control group [Relative Risk (RR) = 1.21, 95% CI = (1.12, 1.30), P < 0.01]. Moreover, the serum phosphorus levels [MD = -0.34, 95% CI = (-0.39, -0.29), P < 0.01], serum calcium levels [MD = -0.09, 95% CI = (-0.14, -0.05), P < 0.01], serum intact parathyroid hormone (iPTH) levels [MD = -35.05, 95% CI = (-45.31, -24.796), P < 0.01], and the incidence of adverse reactions [RR = 1.22, 95% CI = (1.08, 1.39), P < 0.01] were all lower in the experimental group compared to those in the control group. The funnel plot exhibited symmetrical distribution, and Egger's and Begg's tests did not reveal any evidence of significant publication bias (all P > 0.05).
The combined use of lanthanum carbonate and calcium carbonate demonstrates a superior clinical efficacy in the management of hyperphosphatemia in hemodialysis patients, as compared to the use of calcium carbonate as a standalone treatment. To corroborate these findings, it is essential to conduct additional multi-center, RCTs with substantial sample sizes.
通过对随机对照试验（RCT）的荟萃分析，全面研究碳酸镧联合碳酸钙治疗血液透析高磷血症患者的疗效和安全性。
我们在PubMed、Embase和Web of Science数据库中检索了关于碳酸镧联合碳酸钙治疗血液透析高磷血症患者效果的RCT。检索涵盖了从数据库建立到2023年10月的所有研究。对符合条件的研究进行数据提取和质量评估，然后使用RevMan5.3软件进行荟萃分析。
纳入了10项符合纳入标准的研究，样本量为475例患者（实验组256例接受碳酸镧和碳酸钙；对照组219例仅接受碳酸钙）。与对照组相比，实验组的临床缓解率显著更高[相对危险度（RR）=1.21，95%可信区间（CI）=(1.12, 1.30)，P<0.01]。此外，实验组的血清磷水平[平均差（MD）=-0.34，95%CI=(-0.39, -0.29)，P<0.01]、血清钙水平[MD=-0.09，95%CI=(-0.14, -0.05)，P<0.01]、血清完整甲状旁腺激素（iPTH）水平[MD=-35.05，95%CI=(-45.31, -24.796)，P<0.01]以及不良反应发生率[RR=1.22，95%CI=(1.08, 1.39)，P<0.01]均低于对照组。漏斗图呈对称分布，Egger检验和Begg检验均未发现明显的发表偏倚证据（所有P>0.05）。
与单独使用碳酸钙相比，碳酸镧联合碳酸钙在治疗血液透析高磷血症患者方面显示出更好的临床疗效。为证实这些发现，有必要开展更多样本量充足的多中心RCT。
