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DC Field | Value | Language |
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dc.contributor.author | Navaneethan, Sankar D | - |
dc.contributor.author | Palmer, Suetonia C | - |
dc.contributor.author | Craig, Jonathan C | - |
dc.contributor.author | Elder, Grahame J. | - |
dc.contributor.author | Strippoli, Giovanni F M | - |
dc.date.accessioned | 2022-06-23T05:14:57Z | - |
dc.date.available | 2022-06-23T05:14:57Z | - |
dc.date.issued | 2009 | - |
dc.identifier.citation | American Journal of Kidney Diseases 54(4):619-637, 2009 | - |
dc.identifier.uri | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/3320 | - |
dc.description.abstract | BACKGROUND: Phosphate binders are widely used to control serum phosphorus levels in patients with chronic kidney disease (CKD). We analyzed the effects of phosphate binders on biochemical and patient-level end points in patients with CKD. STUDY DESIGN: Systematic review and meta-analysis by searching MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), and the Cochrane Renal Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL). SETTING & POPULATION: Patients with CKD. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials. INTERVENTION: Phosphate binders. OUTCOMES: Serum phosphorus, calcium, and parathyroid hormone levels; incidence of hypercalcemia; all-cause mortality; adverse effects. RESULTS: 40 trials (6,406 patients) were included. There was no significant decrease in all-cause mortality (10 randomized controlled trials; 3,079 patients; relative risk [RR], 0.73; 95% confidence interval [CI], 0.46 to 1.16), hospitalization, or end-of-treatment serum calcium-phosphorus product levels with sevelamer compared with calcium-based agents. There was a significant decrease in end-of-treatment phosphorus and parathyroid hormone levels with calcium salts compared with sevelamer and a significant decrease in risk of hypercalcemia (RR, 0.47; 95% CI, 0.36 to 0.62) with sevelamer compared with calcium-based agents. There was a significant increase in risk of gastrointestinal adverse events with sevelamer in comparison to calcium salts (RR, 1.39; 95% CI, 1.04 to 1.87). Compared with calcium-based agents, lanthanum significantly decreased end-of-treatment serum calcium and calcium-phosphorus product levels, but with similar end-of-treatment phosphorus levels. Effects of calcium acetate on biochemical end points were similar to those of calcium carbonate. Existing data are insufficient to conclude for a differential impact of any phosphate binder on cardiovascular mortality or other patient-level outcome. LIMITATIONS: Few long-term studies of the efficacy of phosphate binders on mortality and musculoskeletal morbidity, significant heterogeneity for many surrogate outcomes, and suboptimal reporting of study methods to determine trial quality. CONCLUSION: Currently, there are insufficient data to establish the comparative superiority of non-calcium-binding agents over calcium-containing phosphate binders for such important patient-level outcomes as all-cause mortality and cardiovascular end points. Additional trials are still required to examine the differential effects of phosphate-binding agents on these end points and the mineral homeostasis pathway. | - |
dc.title | Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials | - |
dc.type | Journal Article | - |
dc.identifier.doi | https://doi.org/10.1053/j.ajkd.2009.06.004 | - |
dc.subject.keywords | Acetates | - |
dc.subject.keywords | Biomarkers | - |
dc.subject.keywords | Calcium | - |
dc.subject.keywords | Calcium Carbonate | - |
dc.subject.keywords | Chelating Agents | - |
dc.subject.keywords | Chronic Kidney Disease-Mineral and Bone | - |
dc.subject.keywords | Disorder | - |
dc.subject.keywords | Hypercalcemia | - |
dc.subject.keywords | Hyperphosphatemia | - |
dc.subject.keywords | Lanthanum | - |
dc.subject.keywords | Parathyroid Hormone | - |
dc.subject.keywords | Phosphates | - |
dc.subject.keywords | Polyamines | - |
dc.subject.keywords | Renal Insufficiency, Chronic | - |
dc.identifier.journaltitle | American Journal of Kidney Diseases | - |
dc.identifier.department | Renal | - |
dc.identifier.pmid | 19692157 | - |
dc.contributor.wslhd | Elder, Grahame J. | - |
dc.identifier.affiliation | Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH | - |
dc.identifier.affiliation | Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand | - |
dc.identifier.affiliation | Cochrane Renal Group, NHMRC Centre for Clinical Research Excellence in Renal Medicine, The Children's Hospital at Westmead, Westmead | - |
dc.identifier.affiliation | School of Public Health, University of Sydney, Sydney, Australia | - |
dc.identifier.affiliation | Centre for Transplant and Renal Research, Westmead Millennium Institute, Sydney, Australia | - |
dc.identifier.affiliation | Department of Pharmacology and Clinical Epidemiology, Renal Division, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy | - |
dc.identifier.affiliation | DIAVERUM Medical Scientific Office, Lund, Sweden | - |
dc.identifier.facility | Westmead | - |
dc.identifier.facility | Auburn | - |
Appears in Collections: | Blacktown Mount Druitt Hospital |
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