The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials
Background: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.Methods: Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Libr...
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1206366/full |
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| author | Hsiao-Tien Chen Kuo-Chuan Hung Kuo-Chuan Hung Chin-Wei Hsu Chin-Wei Hsu Jui-Yi Chen Jui-Yi Chen Chien-Cheng Liu I-Wen Chen Cheuk-Kwan Sun Cheuk-Kwan Sun |
| author_facet | Hsiao-Tien Chen Kuo-Chuan Hung Kuo-Chuan Hung Chin-Wei Hsu Chin-Wei Hsu Jui-Yi Chen Jui-Yi Chen Chien-Cheng Liu I-Wen Chen Cheuk-Kwan Sun Cheuk-Kwan Sun |
| author_sort | Hsiao-Tien Chen |
| collection | DOAJ |
| description | Background: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.Methods: Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti Library, and other major Chinese databases until 1 February 2023. The primary outcome was circulating phosphate concentration, while secondary outcomes included circulating calcium and intact parathyroid hormone levels, calcium–phosphorus product, and treatment-related side-effects.Results: Analysis of nine studies published between 2000 and 2019 including 726 participants showed a lower circulating phosphate concentration in the cuttlebone group than in controls [mean difference (MD) = −0.23, 95% CI: −0.39 to −0.06, p = 0.006, I2 = 94%, 726 patients] and a dose-dependent effect of cuttlebone against hyperphosphatemia. Therapeutic benefits were noted after both short-term (1–2 months) and long-term (3–6 months) treatments. Besides, patients receiving hemodialysis showed a better response to cuttlebone than those receiving peritoneal dialysis. There was no difference in circulating calcium level (mean difference = 0.03, 95% CI: −0.01 to 0.07, p = 0.17, I2 = 34%, 654 patients), while patients receiving cuttlebone showed lower circulating iPTH level and calcium-phosphorus product (MD = −43.63, 95% CI: −74.1 to −13.16, p = 0.005, I2 = 76%, 654 patients), (MD = −0.38, 95% CI: −0.38 to −0.01, p = 0.04, I2 = 83%, 520 patients). No difference in the risks of constipation, gastrointestinal discomfort, and elevated blood calcium was noted between the two groups.Conclusion: Compared with conventional phosphate-binding agents, cuttlebone more efficiently suppressed hyperphosphatemia with a dose-dependent effect. The limited number of included studies warrants further clinical investigations to verify our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023396300. |
| first_indexed | 2024-03-12T22:08:18Z |
| format | Article |
| id | doaj.art-aa596bfc48d34661976afe57cb355020 |
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| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-12T22:08:18Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-aa596bfc48d34661976afe57cb3550202023-07-24T09:23:24ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-07-011410.3389/fphar.2023.12063661206366The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trialsHsiao-Tien Chen0Kuo-Chuan Hung1Kuo-Chuan Hung2Chin-Wei Hsu3Chin-Wei Hsu4Jui-Yi Chen5Jui-Yi Chen6Chien-Cheng Liu7I-Wen Chen8Cheuk-Kwan Sun9Cheuk-Kwan Sun10Department of Chinese Medicine, Chi Mei Medical Center, Tainan City, TaiwanSchool of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Tainan City, TaiwanDepartment of Pharmacy, Chi Mei Medical Center, Tainan City, TaiwanSchool of Pharmacy, Kaohsiung Medical University, Kaohsiung City, TaiwanDivision of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan City, TaiwanDepartment of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, TaiwanDepartment of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan0Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan1School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, TaiwanBackground: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.Methods: Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti Library, and other major Chinese databases until 1 February 2023. The primary outcome was circulating phosphate concentration, while secondary outcomes included circulating calcium and intact parathyroid hormone levels, calcium–phosphorus product, and treatment-related side-effects.Results: Analysis of nine studies published between 2000 and 2019 including 726 participants showed a lower circulating phosphate concentration in the cuttlebone group than in controls [mean difference (MD) = −0.23, 95% CI: −0.39 to −0.06, p = 0.006, I2 = 94%, 726 patients] and a dose-dependent effect of cuttlebone against hyperphosphatemia. Therapeutic benefits were noted after both short-term (1–2 months) and long-term (3–6 months) treatments. Besides, patients receiving hemodialysis showed a better response to cuttlebone than those receiving peritoneal dialysis. There was no difference in circulating calcium level (mean difference = 0.03, 95% CI: −0.01 to 0.07, p = 0.17, I2 = 34%, 654 patients), while patients receiving cuttlebone showed lower circulating iPTH level and calcium-phosphorus product (MD = −43.63, 95% CI: −74.1 to −13.16, p = 0.005, I2 = 76%, 654 patients), (MD = −0.38, 95% CI: −0.38 to −0.01, p = 0.04, I2 = 83%, 520 patients). No difference in the risks of constipation, gastrointestinal discomfort, and elevated blood calcium was noted between the two groups.Conclusion: Compared with conventional phosphate-binding agents, cuttlebone more efficiently suppressed hyperphosphatemia with a dose-dependent effect. The limited number of included studies warrants further clinical investigations to verify our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023396300.https://www.frontiersin.org/articles/10.3389/fphar.2023.1206366/fullcuttleboneserum phosphatemeta-analysisend-stage renal diseasephosphate-binding agents |
| spellingShingle | Hsiao-Tien Chen Kuo-Chuan Hung Kuo-Chuan Hung Chin-Wei Hsu Chin-Wei Hsu Jui-Yi Chen Jui-Yi Chen Chien-Cheng Liu I-Wen Chen Cheuk-Kwan Sun Cheuk-Kwan Sun The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials Frontiers in Pharmacology cuttlebone serum phosphate meta-analysis end-stage renal disease phosphate-binding agents |
| title | The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials |
| title_full | The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials |
| title_fullStr | The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials |
| title_short | The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials |
| title_sort | efficacy and safety of cuttlebone for lowering serum phosphate in patients with end stage renal disease a meta analysis of randomized controlled trials |
| topic | cuttlebone serum phosphate meta-analysis end-stage renal disease phosphate-binding agents |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1206366/full |
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