Effects of Phosphate-lowering Agents in Non-Dialysis Chronic Kidney Disease

The effects of phosphate-lowering treatments on clinical outcomes in individuals with chronic kidney disease (CKD) are unknown; systematic studies have mostly focused on dialysis patients.

In a study conducted by Nicole Lioufas it was found that Non calcium-based phosphate-lowering treatment decreased blood phosphate and urine phosphate excretion, but the effect on clinical outcomes and intermediate cardiovascular end-points was equivocal.

The findings of this study were published in Journal of the American Society of Nephrology on 13th October, 2021.

The purpose of this study was to compile information from randomized controlled trials (RCTs) on the advantages and hazards of non-calcium-based phosphate-lowering therapy in non-dialysis CKD.

A comprehensive review and meta-analyses of RCTs comparing non-calcium-based phosphate-lowering treatment to placebo, calcium-based binders, or no study medication in people with CKD who were not on dialysis or post-transplant were performed. RCTs included a three-month follow-up period, and outcomes included mineral metabolism biomarkers, cardiovascular parameters, and adverse events. The Sidik-Jonkman technique for random effects was used to meta-analyze the outcomes. For continuous outcomes, unstandardized mean differences were utilized as effect sizes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. For binary outcomes, odds ratios were employed. The certainty of evidence was evaluated by the Cochrane risk of bias and GRADE evaluation.

In this Study Twenty trials with a total of 2,498 individuals were considered for inclusion. The danger of bias was minimal overall. Non Calcium-based phosphate binders decreased blood phosphate and urine phosphate excretion compared to placebo, but resulted with increased constipation and a higher vascular calcification score. There was a scarcity of data on the impact of phosphate-lowering treatment on cardiovascular events and mortality.

In conclusion, to assess the advantages and hazards of phosphate-lowering treatment on patient-centered outcomes, adequately powered RCTs are necessary.

Reference:

Lioufas, N., Pascoe, E., Hawley, C., Elder, G., Badve, S., Block, G., Johnson, D., & Toussaint, N. (2021). Systematic Review and Meta-analyses of Effects of Phosphate-lowering Agents in Non-dialysis Chronic Kidney Disease. In Journal of the American Society of Nephrology (p. ASN.2021040554). American Society of Nephrology (ASN). https://doi.org/10.1681/asn.2021040554