Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD

Abstract

Background and objectives People with CKD stages 3-5 and on dialysis (5D) have dramatically increased mortality, which has been associated with hyperphosphatemia in many studies. Oral phosphate binders are commonly prescribed to lower serum phosphate. We conducted an updated meta-analysis of the noncalcium-based binder (non-CBB) sevelamer versus CBBs in CKD stages 3-5D.Design, setting, participants, & measurements Randomized, controlled trials comparing sevelamer with CBBs were identified through MEDLINE and the Cochrane Central Register of Controlled Trials. Patient-level outcomes included all-cause mortality, cardiovascular events and mortality, hospitalization, and adverse effects. Intermediate outcomes included vascular calcification and bone changes. Biochemical outcomes included serum phosphate, calcium, parathyroid hormone, lipids, and hypercalcemia. We conducted and reported this review according to Cochrane guidelines. ResultsWe included 25 studies to March 31, 2015 with 4770 participants (88% on hemodialysis). Patients receiving sevelamer had lower all-cause mortality (risk ratio [RR], 0.54; 95% confidence interval [95% CI], 0.32 to 0.93), no statistically significant difference in cardiovascular mortality (n=2712; RR, 0.33; 95% CI, 0.07 to 1.64), and an increase in combined gastrointestinal events of borderline statistical significance (n=384; RR, 1.42; 95% CI, 0.97 to 2.08). For biochemical outcomes, patients receiving sevelamer had lower total serum cholesterol (mean difference [MD], 220.2 mg/dl; 95% CI, 225.9 to 214.5 mg/dl), LDL-cholesterol (MD, 221.6 mg/dl; 95% CI, 227.9 to 215.4 mg/dl), and calcium (MD, 20.4 mg/dl; 95% CI, 20.6 to 20.2 mg/dl) and a reduced risk of hypercalcemia (RR, 0.30; 95% CI, 0.19 to 0.48). End of treatment intact parathyroid hormone was significantly higher for sevelamer (MD, 32.9 pg/ml; 95% CI, 0.1 to 65.7 pg/ml). Serum phosphate values showed no significant differences.Conclusions Patients with CKD stages 3-5D using sevelamer have lower all-cause mortality compared with those using CBBs. Because of a lack of placebo-controlled studies, questions remain regarding phosphate binder benefits for patients with CKD stages 3-5 and not on dialysis.

Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis

“…Moreover, calcium-based phosphate binders have been associated with vascular calcification and all-cause mortality. 9,13,14 Importantly, the current treatment paradigm is inadequate to control hyperphosphatemia in the majority of patients receiving dialysis, because the mean serum phosphate concentration among these patients in the United States remains well above the upper end of the population reference range. 9 Data from clinical trials of currently approved phosphate binders in patients receiving hemodialysis show that mean reductions in serum phosphate of 1.2-2.2 mg/dl are typically achievable over treatment periods of 2-52 weeks.…”

Clinical Practices and Therapeutic Management of Mineral and Bone Disorders in Chronic Kidney Disease 4, 5 and 5D: The OCEANOS Study in Iran

“…In a recent meta-analysis conducted by Jamal et al, a 22%-decrease in mortality was observed after using noncalcium phosphate binders (sevelamer and lanthanum) (14). In addition, according to the results of a study by Elder et al the use of sevelamer, as compared with calcium carbonate, was associated with less mortality in the patients with stage 3-5D CKD (29). As the current results showed, the studied patients were at a high risk of calcification and a moderate risk of hypercalcemia (Tables 4, 7).…”

Медикаментозная Коррекция Нарушений Фосфатно-Кальциевого Обмена У Пациентов С Хронической Болезнью Почек И Минерально-Костной Болезнью

“…По результатам анализа у пациентов, получавших в качестве терапии севе-ламер, наблюдался низкий риск развития гипер-кальциемии, уровень холестерина крови также был ниже, чем в группах с кальцийсодержащими пре-паратами. Во всех случаях применение севеламера в данной группе пациентов было связано с более низ-ким общим уровнем смертности [14].…”