Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients

AbstractThis 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 Infrast...

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Main Authors: Qian Zeng, Yuanlong Zhong, Xiqiu Yu
Format: Article
Language:English
Published: Taylor & Francis Group 2023-12-01
Series:Renal Failure
Subjects:
Online Access:https://www.tandfonline.com/doi/10.1080/0886022X.2023.2210230
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author Qian Zeng
Yuanlong Zhong
Xiqiu Yu
author_facet Qian Zeng
Yuanlong Zhong
Xiqiu Yu
author_sort Qian Zeng
collection DOAJ
description AbstractThis 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.
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spelling doaj.art-e6e3de2992874d5e8472eedb679d77f92023-10-17T09:23:24ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145110.1080/0886022X.2023.2210230Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patientsQian Zeng0Yuanlong Zhong1Xiqiu Yu2Department of General Practice, Shenzhen Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, PR ChinaDepartment of Nephrology, Shenzhen Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, PR ChinaDepartment of Gastroenterology, Shenzhen Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, PR ChinaAbstractThis 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.https://www.tandfonline.com/doi/10.1080/0886022X.2023.2210230Sevelamerhyperphosphatemiachronic kidney diseasemeta-analysis
spellingShingle Qian Zeng
Yuanlong Zhong
Xiqiu Yu
Meta-analysis of the efficacy and safety of sevelamer as hyperphosphatemia therapy for hemodialysis patients
Renal Failure
Sevelamer
hyperphosphatemia
chronic kidney disease
meta-analysis
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 Sevelamer
hyperphosphatemia
chronic kidney disease
meta-analysis
url https://www.tandfonline.com/doi/10.1080/0886022X.2023.2210230
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AT xiqiuyu metaanalysisoftheefficacyandsafetyofsevelamerashyperphosphatemiatherapyforhemodialysispatients