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Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients
This study was designed to examine the relative safety and efficacy of sevelamer in the treatment of chronic kidney disease (CKD) patients in comparison to placebo, calcium carbonate (CC), or lanthanum carbonate (LC). The PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Taylor & Francis
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243412/ https://www.ncbi.nlm.nih.gov/pubmed/37272189 http://dx.doi.org/10.1080/0886022X.2023.2210230 |
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author | Zeng, Qian Zhong, Yuanlong Yu, Xiqiu |
author_facet | Zeng, Qian Zhong, Yuanlong Yu, Xiqiu |
author_sort | Zeng, Qian |
collection | PubMed |
description | This study was designed to examine the relative safety and efficacy of sevelamer in the treatment of chronic kidney disease (CKD) patients in comparison to placebo, calcium carbonate (CC), or lanthanum carbonate (LC). The PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were searched for articles published through 18 June 2022. The quality of relevant studies was independently analyzed by two investigators who also extracted data from these manuscripts as per Cochrane Collaboration Handbook 5.3. The safety and efficacy of sevelamer as a treatment for hyperphosphatemia in CKD patients were then examined through a meta-analysis, with the primary patient-level outcomes of interest in this analysis being all-cause mortality and the incidence of gastrointestinal adverse effects. Vascular calcification score was also examined as an intermediate outcome, while serum biochemical parameters including levels of phosphate (P), calcium (Ca), intact parathyroid hormone (iPTH), lipids, C-reactive protein (CRP), or fibroblast growth factor-23 (FGF-23) were additionally assessed. In total, this meta-analysis incorporated data from 34 randomized controlled trials (RCTs) enrolling 2802 patients. Sevelamer was associated with reduced all-cause mortality (RR 0.28, CI 0.19 − 0.41, very low certainty) and Vessel calcification score (RR −0.58, CI −1.11 to −0.04, low certainty) and induced less hypercalcemia (MD −0.28, CI 0.40 to −0.16, low certainty) and hyperphosphatemia (MD −0.22, CI −0.32 to −0.13, low certainty) when compared with Ca-based binders in CKD5D individuals. No significant differences in gastrointestinal adverse events (GAEs) incidence were observed. These data suggest that sevelamer may represent a beneficial means of protecting CKD patients against death and vessel calcification when used to treat hyperphosphatemia, while we found no clinically important benefits in decreasing gastrointestinal adverse effects. |
format | Online Article Text |
id | pubmed-10243412 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-102434122023-06-07 Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients Zeng, Qian Zhong, Yuanlong Yu, Xiqiu Ren Fail Review Article This study was designed to examine the relative safety and efficacy of sevelamer in the treatment of chronic kidney disease (CKD) patients in comparison to placebo, calcium carbonate (CC), or lanthanum carbonate (LC). The PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were searched for articles published through 18 June 2022. The quality of relevant studies was independently analyzed by two investigators who also extracted data from these manuscripts as per Cochrane Collaboration Handbook 5.3. The safety and efficacy of sevelamer as a treatment for hyperphosphatemia in CKD patients were then examined through a meta-analysis, with the primary patient-level outcomes of interest in this analysis being all-cause mortality and the incidence of gastrointestinal adverse effects. Vascular calcification score was also examined as an intermediate outcome, while serum biochemical parameters including levels of phosphate (P), calcium (Ca), intact parathyroid hormone (iPTH), lipids, C-reactive protein (CRP), or fibroblast growth factor-23 (FGF-23) were additionally assessed. In total, this meta-analysis incorporated data from 34 randomized controlled trials (RCTs) enrolling 2802 patients. Sevelamer was associated with reduced all-cause mortality (RR 0.28, CI 0.19 − 0.41, very low certainty) and Vessel calcification score (RR −0.58, CI −1.11 to −0.04, low certainty) and induced less hypercalcemia (MD −0.28, CI 0.40 to −0.16, low certainty) and hyperphosphatemia (MD −0.22, CI −0.32 to −0.13, low certainty) when compared with Ca-based binders in CKD5D individuals. No significant differences in gastrointestinal adverse events (GAEs) incidence were observed. These data suggest that sevelamer may represent a beneficial means of protecting CKD patients against death and vessel calcification when used to treat hyperphosphatemia, while we found no clinically important benefits in decreasing gastrointestinal adverse effects. Taylor & Francis 2023-06-05 /pmc/articles/PMC10243412/ /pubmed/37272189 http://dx.doi.org/10.1080/0886022X.2023.2210230 Text en © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. |
spellingShingle | Review Article Zeng, Qian Zhong, Yuanlong Yu, Xiqiu Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title | Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title_full | Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title_fullStr | Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title_full_unstemmed | Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title_short | Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
title_sort | meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243412/ https://www.ncbi.nlm.nih.gov/pubmed/37272189 http://dx.doi.org/10.1080/0886022X.2023.2210230 |
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