The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis

Abstract

Sevelamer was associated with a nonsignificant reduction in mortality and significantly lower hospitalization rates and hypercalcemia compared with calcium-based binders. However, differences in important outcomes, such as cardiac events, fractures, calciphylaxis, hyperchloremic acidosis and health-related quality of life remain understudied. Lanthanum and iron-based binders did not show superiority for any clinically relevant outcomes. Future studies that fail to measure clinically important outcomes (the reason why phosphate binders are prescribed in the first place) will be wasteful.

Mineral bone disorders in chronic kidney disease

“…Among the phosphate binders, calcium‐based phosphate binders hindered the effect of vitamin D because of the risk of hypercalcemia . Calcium‐free phosphate binders such as sevelamer or lanthanum decreases the intestinal calcium loading, and it provided the benefit in mortality in contrast to the calcium‐based phosphate binder . The calcium‐sensing receptor (CaSR) is important in regulating PTH secretion and therefore, this target offers the potential to suppress PTH secretion by complementary mechanism to vitamin D analogues.…”

“…16 Calcium-free phosphate binders such as sevelamer or lanthanum decreases the intestinal calcium loading, and it provided the benefit in mortality in contrast to the calcium-based phosphate binder. 17,18 The calcium-sensing receptor (CaSR) is important in regulating PTH secretion and therefore, this target offers the potential to suppress PTH secretion by complementary mechanism to vitamin D analogues. Calcimimetics allosterically enhance the sensitivity of CaSR in the parathyroid glands to calcium.…”

Do Calcium‐based Phosphate binders Accelerate or Prevent Coronary Artery Calcification in Dialysis Patients?

“…(Although they could not show conclusively whether the use of these drugs improved the prognosis in patients requiring hemodialysis or whether the patients who were prescribed these drugs initially had a better prognosis.) This could explain why a recent meta‐analysis could not obtain definitive evidence of superiority of sevelamer hydrochloride or lanthanum carbonate against calcium‐based phosphate binders in the prognosis and occurrence of cardiac events in patients on dialysis . In addition, another meta‐analysis could also not obtain definitive evidence of the superiority of sevelamer hydrochloride against calcium‐based phosphate binders on cardiovascular mortality and calcification of coronary artery .…”

Critical Care Management and Newer Therapies for Tumour Lysis Syndrome

“…Important consideration should be given to TLS patients with hypocalcemia. Usually, hypocalcemia-associated with TLS should not be treated with calcium supplementation due to risk of calcium phosphate formation and organ injury [16]. It should be reserved for malignant cardiac arrhythmias (VT/VF), cardiac arrest, and tetany.…”