Cochrane · systematic review · CD006023
Phosphate binders for preventing and treating chronic kidney disease‐mineral and bone disorder (CKD‐MBD)
Ruospo, M, Palmer, SC, Natale, P, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
47
current version
GRADE rated
38
No studies
9
Included studies
NR
No studies 9 · 19.1%Ungraded 0 · 0%Very low 20 · 42.6%Low 16 · 34%Moderate 2 · 4.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings: Sevelamer versus placebo/usual care
Population: people with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings: Sevelamer vs placebo/usual care | RR 2.16 [0.2, 22.8] | 3 studies · 248 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings: Sevelamer vs placebo/usual care | no estimate extracted | NR | No studies |
Hypercalcaemia Summary of findings: Sevelamer vs placebo/usual care | RR 1.9 [0.12, 29.32] | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Nausea Summary of findings: Sevelamer vs placebo/usual care | RR 1.27 [0.07, 22.42] | 3 studies · 370 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings: Sevelamer vs placebo/usual care | RR 2.09 [0.26, 16.57] | 2 studies · 165 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Constipation Summary of findings: Sevelamer vs placebo/usual care | RR 6.92 [2.24, 21.38] | 4 studies · 430 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings: Sevelamer vs placebo/usual care | no estimate extracted | 5 studies · 483 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcification score Summary of findings: Sevelamer vs placebo/usual care | no estimate extracted | 2 studies · 115 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Summary of findings: Lanthanum versus placebo/usual care
Population: people with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings: Lanthanum vs placebo/usual care | RR 1.63 [0.07, 37.12] | 3 studies · 214 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings: Lanthanum vs placebo/usual care | no estimate extracted | NR | No studies |
Nausea Summary of findings: Lanthanum vs placebo/usual care | RR 3.72 [1.36, 10.18] | 4 studies · 383 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings: Lanthanum vs placebo/usual care | RR 2.76 [0.41, 18.63] | 3 studies · 261 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Constipation Summary of findings: Lanthanum vs placebo/usual care | RR 2.98 [1.21, 7.3] | 4 studies · 299 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings: Lanthanum vs placebo/usual care | no estimate extracted | 4 studies · 171 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcification score Summary of findings: Lanthanum vs placebo/usual care | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Summary of findings: Iron versus placebo/usual care
Population: people with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings: Iron vs placebo/usual care | RR 0.52 [0.06, 4.65] | 2 studies · 239 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings: Iron vs placebo/usual care | no estimate extracted | NR | No studies |
Hypercalcaemia Summary of findings: Iron vs placebo/usual care | no estimate extracted | NR | No studies |
Nausea Summary of findings: Iron vs placebo/usual care | RR 0.99 [0.3, 3.27] | 1 study · 149 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings: Iron vs placebo/usual care | no estimate extracted | NR | No studies |
Constipation Summary of findings: Iron vs placebo/usual care | RR 2.66 [1.15, 6.12] | 3 studies · 422 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings: Iron vs placebo/usual care | no estimate extracted | 3 studies · 422 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcification score Summary of findings: Iron vs placebo/usual care | no estimate extracted | NR | No studies |
Summary of findings: Calcium versus placebo/usual care
Population: people with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings: Calcium vs placebo/usual care | RR 0.46 [0.05, 4.32] | 1 study · 110 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings: Calcium vs placebo/usual care | no estimate extracted | NR | No studies |
Hypercalcaemia Summary of findings: Calcium vs placebo/usual care | RR 7.28 [1.64, 32.2] | 3 studies · 215 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Nausea Summary of findings: Calcium vs placebo/usual care | RR 0.58 [0.15, 2.18] | 2 studies · 197 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings: Calcium vs placebo/usual care | no estimate extracted | NR | No studies |
Constipation Summary of findings: Calcium vs placebo/usual care | RR 2.44 [0.32, 18.4] | 2 studies · 197 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings: Calcium vs placebo/usual care | no estimate extracted | 3 studies · 151 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcification score Summary of findings: Calcium vs placebo/usual care | no estimate extracted | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Summary of findings: Sevelamer versus calcium
Population: people with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings: Sevelamer vs calcium | RR 0.53 [0.3, 0.91] | 16 studies · 3688 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings: Sevelamer vs calcium | RR 0.45 [0.11, 1.77] | 6 studies · 2829 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Hypercalcaemia Summary of findings: Sevelamer vs calcium | RR 0.3 [0.2, 0.43] | 19 studies · 4084 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Nausea Summary of findings: Sevelamer vs calcium | RR 0.98 [0.56, 1.71] | 4 studies · 365 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings: Sevelamer vs calcium | RR 0.95 [0.54, 1.69] | 2 studies · 263 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Constipation Summary of findings: Sevelamer vs calcium | RR 1.35 [0.71, 2.57] | 6 studies · 2652 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings: Sevelamer vs calcium | no estimate extracted | 23 studies · 4360 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcium score Summary of findings: Sevelamer vs calcium | no estimate extracted | 4 studies · 517 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Summary of findings ‐ Lanthanum versus calcium
Population: patients with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Summary of findings ‐ Lanthanum vs calcium | RR 0.76 [0.18, 3.11] | 6 studies · 505 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Cardiovascular death Summary of findings ‐ Lanthanum vs calcium | no estimate extracted | NR | No studies |
Hypercalcaemia Summary of findings ‐ Lanthanum vs calcium | RR 0.16 [0.06, 0.43] | 8 studies · 1347 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Nausea Summary of findings ‐ Lanthanum vs calcium | RR 1.65 [0.95, 2.89] | 5 studies · 1191 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Vomiting Summary of findings ‐ Lanthanum vs calcium | RR 3.88 [0.48, 31.7] | 2 studies · 1058 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Constipation Summary of findings ‐ Lanthanum vs calcium | RR 0.79 [0.5, 1.26] | 5 studies · 1213 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serum phosphate level Summary of findings ‐ Lanthanum vs calcium | no estimate extracted | 9 studies · 400 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Coronary artery calcium score Summary of findings ‐ Lanthanum vs calcium | no estimate extracted | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |