Network Meta-analysis of phosphate binders for treatment of hyperphosphatemia in chronic kidney disease patients on dialysis
Objective:To systematically evaluate the safety and efficacy of phosphate binders in chronic kidney disease patients on dialysis.Methods:Medline,Embase and Cochrane Library were retrieved to collect randomized controlled trials about phosphate binders in chronic kidney disease patients on dialysis from the inception of the database to December 31,2023.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Bayes network Meta-analysis was then performed using gemtc package in R4.2.1 software.Results:A total of 20 studies including 7156 patients were included.Results of network Meta-analysis showed that no statistically significant differences were observed between different phosphorus binders in efficacy indicators such as blood phosphorus level and serum phosphorus compliance rate,as well as safety indicators such as parathyroid hormone,incidence of adverse events,and withdrawal rate due to adverse events.However,calcium-based binders including calcium acetate and calcium carbonate significantly increased serum calcium level in patients.The probability ranking diagram of pill burden indicated that sucroferric oxyhydroxide had the highest probability of the lowest pill burden,while sevelamer hydrochloride had the lowest probability of the lowest pill burden.Conclusion:The current evidence suggests that all phosphate binders can effectively control hyperphosphatemia in chronic kidney disease patients on dialysis,and there is no significant difference in the main safety indicators.However,calcium-based binders can significantly increase the serum calcium level of patients,which may increase the risk of cardiovascular events.The pill burden of sucroferric oxyhydroxide is significantly lower,which may lead to higher medication compliance.
万方数据
维普
