Phosphate-binder therapy does not reduce mortality risk compared with placebo among adult patients with chronic kidney disease (CKD), according to a recent meta-analysis.

Suetonia C. Palmer, PhD, of the University of Otago Christchurch in Christchurch, New Zealand, and colleagues analyzed data from 12,562 adult CKD patients—predominantly those on dialysis—participating in 77 randomized trials with allocation to phosphate binders. Twenty studies ascertained all-cause mortality during 86,744 patient-months of follow-up.

Results showed no evidence that any drug class decreased mortality or cardiovascular events compared with placebo, the investigators reported online ahead of print in the American Journal of Kidney Diseases. Compared with calcium binders, sevelamer decreased all-cause mortality significantly (by 61%), but lanthanum, iron, and coletilan binders did not.

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“It is not clear whether the higher mortality with calcium versus sevelamer reflects whether there is net harm associated with calcium, net benefit with sevelamer, both, or neither.”

Except for colestilan, all phosphate binders reduced serum phosphorus levels compared with placebo. Iron-based binders reduced serum phosphate levels to the greatest extent, according to the investigators. “As expected, calcium was ranked as most likely to cause hypercalcemia.”

Lanthanum and colestilan were the binders most likely to cause nausea, sevelamer ranked the worst for constipation, and iron-based binders conferred the highest probability for diarrhea, the investigators reported.

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