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. 2025 Jan 15;15(1):2012.
doi: 10.1038/s41598-024-84942-8.

A network meta-analysis of therapies for hyperphosphatemia in CKD based on randomized trials

Congyang Zheng  1   2 , Jia Liu  3 , Tao Wang  3 , Haiyang Hu  3 , Yuanyuan Chen  4
Affiliations

A network meta-analysis of therapies for hyperphosphatemia in CKD based on randomized trials

Congyang Zheng et al. Sci Rep. .

Abstract

To update the efficacy and safety of different drugs for the treatment of patients with hyperphosphatemia in chronic kidney disease, we conducted a network meta-analysis of 22 therapies for the treatment of uncontrolled hyperphosphatemia in patients with chronic kidney disease (CKD). All randomized controlled trials on hyperphosphatemia published from January 2013 to November 2023 were searched from CNKI, VIP database, Wanfang database, PubMed, Scopus, and Cochrane databases. Meta-analysis was used to evaluate the serum phosphorus, calcium levels, total effective rate and adverse events of patients with chronic kidney disease (CKD). Data collection and quality evaluation were carried out by three evaluators, RevMan (5.5.3) and Stata (1.3.0). A total of 71 RCTs, and 22 treatment strategies were included in this NMA. The results showed that all treatment strategies were effective in improving patients' blood phosphorus levels. Among them, SL + CT, CA + CC, SL and TCM had higher overall efficacy, RT, TCM and SL + CT had lower blood phosphorus levels, SL + CT, SL and NAM had lower blood calcium levels, and OAC, CC, NAM and SL had higher safety. Among them, SL + CT seems to be the most recommended treatment strategy. In addition, multidrug combination strategies usually have a higher efficacy and safety profile.

Keywords: Adverse events; Chronic kidney disease; Hyperphosphatemia; Network meta-analysis; Serum calcium; Serum phosphorus.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) Study selection flowchart search results flowchart and selection of included studies; (B) Methodological quality assessment of risk of bias of included studies.
Fig. 2
Fig. 2
(A) Efficacy ranking of treatment strategies; (B) Sensitivity analysis of this study.
Fig. 3
Fig. 3
(A) Comparison network included in the analysis; (B) ranking of blood phosphorus levels for the 18 treatment strategies; (C) publication bias of this study.
Fig. 4
Fig. 4
(A) Comparison network included in the analysis; (B) ranking of blood calcium levels for the 17 treatment strategies; (C) publication bias of this study.
Fig. 5
Fig. 5
(A) Comparison network included in the analysis; (B) ranking of adverse effects of the 17 treatment strategies; (C) publication bias of this study.
See this image and copyright information in PMC

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