Iron-based Phosphate Binders For The Treatment Of Hyperphosphatemia In Chronic Kidney Disease:A Systematic Review Of Clinical Randomized Controlled Trials

Background: Hyperphosphatemia and anemia are common debilitating complications of chronic kidney disease(CKD,especially CKD stage3-5,that can simultaneously occur in patients.However,the appropriate treatment for CKD patients with both hyperphosphatemia and anemia is unclear.Recently,several studies have shown that the iron-based phosphate binder provides benefits for both hyperphosphatemia and anemia.Objective: We performed this meta-analysis to evaluate the efficacy and safety of iron-based phosphate binder for treating hyperphosphatemia and anemia in CKD patients.Methods: We searched all related records in databases including China National Knowledge Internet,Chinese Biomedical Literature Database,the Cochrane Central Register of Controlled Trials,PUBMED,EMBASE and MEDLINE.The studies included in our meta-analysiswere strictly determined according to the inclusion and exclusion criteria.The quality of the included studies was evaluated by using the Jadad score sheet and the meta-analysis was performed by RevMan software(version 5.30).Result: Our review included 19 studies based on 14 randomized clinical trials(RCT)involving 3268 participants.Comparisons to placebo controls showed that iron-based phosphate binder induced a decrease in the serum phosphorus level(SMD-1.38,95%CI(-1.74,-1.02);P<0.00001)and increase in the hemoglobin level(MD 0.57,95%CI(0.34,0.80);P<0.00001),serum calcium level(MD 0.29,95%CI(0.17,0.41);P<0.00001),ferritin level(MD 71.81,95%CI(19.41,124.22);P=0.007)as well as transferrin saturation(MD 8.87,95%CI(5.20,12.55);P<0.00001)in patients with CKD.But no serious hypercalcemia and iron overload was associated with iron-based phosphate binder.In the common side effects,only a higher incidence of gastrointestinal disorder,discolored feces,constipation and diarrhea was related to iron-based phosphate binder.There was no significant statistical difference in nausea,vomiting,abdominal distension,abdominal pain,abdominal discomfort,dyspepsia and rashes.Moreover,iron-based phosphate binder was shown to be effective in improving hemoglobin levels(SMD 1.51,95%CI(0.49,2.53);P=0.004)compared to sevelamer.However,there was no significant statistical difference in the serum phosphorus level(SMD 0.39,95%CI(-0.95,1.73);P=0.57)and serum calcium level(SMD 0.12,95%CI(-0.01,0.26);P=0.08)between iron-based phosphate binder and sevelamer.There was higher incidence of diarrhea and discolored feces in iron-based phosphate binder rather than sevelamer,but a lower incidence of nausea,constipation.Three studies has described that iron-based phosphate binder was an economic treatment associated with lower costs than sevelamer.Conclusion: The iron-based phosphate binder is a safe,economic and effective treatment for CKD patients with hyperphosphatemia and anemia.