Phosphate-Binding Agents in Adults With CKD: A Network Meta-analysis of Randomized Trials

Palmer, Suetonia C.; Gardner, Sharon; Tonelli, Marcello; Mavridis, Dimitris; Johnson, David W.; Craig, Jonathan C.; French, Richard H.; Ruospo, Marinella; Strippoli, Giovanni F.M.

doi:10.1053/j.ajkd.2016.05.015

Cited by 133 publications

(106 citation statements)

References 38 publications

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“…56 More importantly, sevelamer resulted in lower mortality than calcium-based drugs, while the comparative effects of lanthanum, iron-based drugs and colestilan were less certain. 56 Phosphate binders therefore effectively reduce serum phosphate in patients with chronic kidney disease, but it is uncertain whether they improve clinical outcomes. There may be a mortality difference between calciumbased and non-calcium-based binders, but it is not * confidence interval drugs in an era of ultrapure dialysis water quality.…”

Section: -55mentioning

confidence: 99%

Phosphate binders in patients with chronic kidney disease

Chan¹,

Au²,

Francis³

et al. 2017

Aust Prescr

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Section: -55mentioning

confidence: 99%

Phosphate binders in patients with chronic kidney disease

Chan¹,

Au²,

Francis³

et al. 2017

Aust Prescr

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“…There are fewer observations of binder use in non-dialysis CKD [4,7,8,9,17,18,23,24]. Two studies including a randomized interventional trial among the CKD population have found a mortality benefit in those prescribed phosphorus binders [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Among a predominantly male CKD population within the United States Veterans Administration health system, Kovesdy et al [18] reported 39% lower mortality with phosphorus binders but noted no benefit from phosphorus binders on CKD progression. However, a recent meta-analysis of 77 studies, which included 12,562 adults with CKD, found no evidence that phosphate binders lowered mortality [24]. These findings were true for both calcium- and non-calcium-based phosphorus binders.…”

Section: Discussionmentioning

confidence: 99%

Use of Phosphorus Binders among Non-Dialysis Chronic Kidney Disease Patients and Mortality Outcomes

et al. 2017

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Background: Whether the benefits of phosphorus binders extend to those without end stage renal disease is uncertain. Among a large diverse non-dialysis chronic kidney disease (CKD) population with hyperphosphatemia, we sought to evaluate phosphorus binder use and compare mortality risk between patients prescribed and not prescribed binders. Methods: A retrospective cohort study within an integrated health system (January 1, 1998 - December 31, 2012) among CKD patients (age ≥18) was performed. Non-dialysis CKD patients with 2 separate estimated glomerular filtrate rate (eGFR) <30 mL/min/1.73 m² and serum phosphorus ≥5.0 mg/dL within 180 days of eGFR were included. Multivariable cox proportional hazards and inverse probability of treatment-weighted models were used to estimate mortality hazard ratios (HRs) for patients who received phosphorus binders compared to no binders. Results: Among 10,165 study patients, 2,733 subjects (27%) received phosphorus binders. Compared to the no-phosphorus-binder group, the binder group had mortality HRs (95% CI) of 0.86 (0.79-0.94) and 0.86 (0.80-0.93) using traditional multivariable and inverse probability of treatment-weighted models respectively. Sensitivity analyses removing patients who were prescribed binders >180 days after index date revealed no difference in mortality between those with binders and with no binders. Conclusion: Our findings from a real-world clinical environment revealed that 27% of hyperphosphatemic non-dialysis CKD patients were prescribed binders. They also had lower risk of mortality compared to those not prescribed phosphorus binders. However, the lower mortality risk was not observed when we accounted for immortal time bias. Whether phosphorus binder use in CKD improves survival remains to be determined.

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“…The premature CVD experienced by ESKD patients is in part due to accelerated vascular calcification. With declining renal excretion of phosphorus, its accumulation in serum ultimately promotes the conversion of vascular smooth muscle cells towards the osteoblast phenotype [125].…”

Section: Mineral and Bone Disordermentioning

confidence: 99%

“…However, these therapies have only weakly correlated with all-cause and cardiovascular mortality outcomes in a meta-analysis [127]. Furthermore, a recent network meta-analysis of randomised trials concluded that there is currently no evidence that phosphate binders reduce mortality compared to placebo [125]. Similarly, a cumulative meta-analysis of 18 RCTs involving 7446 patients with CKD found that cinacalcet did not influence cardiovascular or all-cause mortality [128].…”

Section: Mineral and Bone Disordermentioning

confidence: 99%

Cardiovascular Disease in Dialysis Patients

Jegatheesan¹,

Yang²,

Krishnasamy³

et al. 2018

Aspects in Dialysis

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Cardiovascular disease (CVD) is highly prevalent in the dialysis population, affecting up to 60% of cohorts. Cardiovascular mortality rates are reported to be ~14 per 100 patient-years, which are 10-to 20-fold greater than those of age-and gender-matched controls. CVD is the primary cause of death in up to 40% of dialysis patients in Australia, New Zealand and the United States. Dialysis patients endure a greater burden of both traditional risk factors for CVD and risk factors related to loss of kidney function that may account for the higher CVD morbidity and mortality. Many cardiology guidelines include chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as coronary heart disease (CHD) risk equivalents. It is therefore important for clinicians to both recognise and optimise the cardiovascular health of patients receiving maintenance dialysis. This chapter will focus on risk factor modification, screening and prevention of CVD in dialysis patients.

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Phosphate-Binding Agents in Adults With CKD: A Network Meta-analysis of Randomized Trials

Cited by 133 publications

References 38 publications

Phosphate binders in patients with chronic kidney disease

Phosphate binders in patients with chronic kidney disease

Use of Phosphorus Binders among Non-Dialysis Chronic Kidney Disease Patients and Mortality Outcomes

Cardiovascular Disease in Dialysis Patients

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