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Meta-Analysis
. 2015 Jul 31;10(7):e0133938.
doi: 10.1371/journal.pone.0133938. eCollection 2015.

New Conclusions Regarding Comparison of Sevelamer and Calcium-Based Phosphate Binders in Coronary-Artery Calcification for Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

Caixia Wang  1 , Xun Liu  1 , Yongming Zhou  2 , Shaomin Li  1 , Yanbing Chen  3 , Yanni Wang  1 , Tanqi Lou  1
Affiliations
Meta-Analysis

New Conclusions Regarding Comparison of Sevelamer and Calcium-Based Phosphate Binders in Coronary-Artery Calcification for Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

Caixia Wang et al. PLoS One. .

Abstract

Background: Sevelamer hydrochloride is used widely, but its impact upon cardiovascular calcification, cardiovascular mortality, all-cause mortality and hospitalization is not known.

Outcomes: Primary outcome was cardiovascular calcification (coronary artery calcification scores (CACS) and aortic calcification scores (ACS)). Secondary outcomes were serum characteristics, hospitalization, cardiovascular mortality and all-cause mortality. Risk ratio (RR), mean differences and standard mean difference with 95% confidence intervals (CIs) were pooled using random- or fixed-effects models.

Results: We identified 31 studies (on 23 randomized controlled trials with 4395 participants). An analysis pooling showed a significant decrease in serum levels of phosphate with calcium-based phosphate binders (CBPBs) by 0.17 mg/dL [mean difference (MD), 95% CI, 0.03, 0.31] than sevelamer. A significant difference in the change of CACS by -102.66 [MD: 95% CI, -159.51, -45.80] and ACS by -1008.73 [MD, 95% CI, -1664.75, -352.72] between sevelamer and CBPBs was observed. Prevalence of hypercalcemia (serum levels of calcium >10.2-10.5 mg/dL and >11.0 mg/dL) was significantly smaller for sevelamer (RR = 0.44, 95% CI, 0.33, 0.58; RR = 0.24, 95% CI, 0.14, 0.40). No significant difference was found in hospitalization, all-cause mortality or cardiovascular mortality.

Conclusions: This meta-analysis suggests that sevelamer benefits dialysis patients in terms of CACS, ACS and hypercalcemia.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of studies considered for inclusion.
Fig 2
Fig 2. Forest plot of the values of phosphorus.
Fig 3
Fig 3. Forest plot of the values of hepercalcemia (above 10.2 mg-dL).
Fig 4
Fig 4. Forest plot of the values of hepercalcemia (above 11.0 mg-dL).
Fig 5
Fig 5. Forest plot of sevelamer vs. calcium phosphate binders on CACS change.
Fig 6
Fig 6. Forest plot of sevelamer vs. calcium phosphate binders on ACS change.
Fig 7
Fig 7. Funnel plot of the value of change of CACS.
See this image and copyright information in PMC

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