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Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review.
JBI Database System Rev Implement Rep. 2019 Jan; 17(1):49-73.JD

Abstract

OBJECTIVES

The objective of the review was to evaluate the effectiveness of the use of phosphate binders on mortality and serum levels of phosphorus, calcium and parathyroid hormone in adult patients with end stage renal disease receiving hemodialysis compared to hemodialysis with no phosphate binder use.

INTRODUCTION

End stage renal disease leading to hemodialysis is a common global health issue. Effective management of this population is focused on balancing alterations in bone mineral markers such as phosphorus, calcium and parathyroid hormone. Chronic imbalances are associated with all-cause mortality. Phosphate binders are a crucial element to regulating these levels.

INCLUSION CRITERIA

The review considered studies including adult patients, age 18 and over, receiving hemodialysis. The intervention of interest was the use of any drug within the class of phosphate binders. Outcomes of interest were all-cause mortality and serum levels of phosphorus, calcium and parathyroid hormone. Experimental and quasi-experimental study designs were considered.

METHODS

A search for relevant published and unpublished literature was conducted through November 5, 2017. Databases searched included PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to gray literature sources. Articles that met the inclusion criteria were further assessed for methodological validity by two independent reviewers using the standard critical appraisal instruments from Joanna Briggs Institute. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. Quantitative data were pooled for statistical meta-analysis to evaluate the impact of phosphate binders on phosphorus and calcium.

RESULTS

Seven studies were included in this review. A meta-analysis of four studies showed that the use of phosphate binders resulted in a statistically significant decrease in phosphorus levels compared to placebo (mean difference -1.89 mg/dL, 95% confidence interval -2.03 mg/dL, -1.75 mg/dL); three additional studies described narratively also showed a statistically significant decrease in phosphorus. A meta-analysis of three studies showed a statistically significant increase in calcium compared to placebo (mean difference 0.57 mg/dL, 95% confidence interval 0.50 mg/dL, 0.64 mg/dL); two additional studies described narratively showed no difference in effect on calcium. Of the three studies that measured parathyroid hormone, one showed a statistically significant improvement with the use of phosphate binders (mean difference -83.0 pg/mL, 95% confidence interval -154.63 pg/mL, -11.37 pg/mL) and two showed no difference in effect. No studies measured mortality.

CONCLUSION

Phosphate binders are effective in reducing serum phosphorus. The findings on parathyroid hormone and calcium did not provide adequate support for phosphate binder use. The impact on mortality was not directly measured in any of the included studies.

Authors+Show Affiliations

College of Health Professions, Pace University, New York, USA. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.College of Health Professions, Pace University, New York, USA. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.College of Health Professions, Pace University, New York, USA. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.College of Health Professions, Pace University, New York, USA. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

30204711

Citation

Gasu, Vivian, et al. "Effectiveness of Phosphate Binders in Adult Patients With End Stage Renal Disease Receiving Hemodialysis: a Systematic Review." JBI Database of Systematic Reviews and Implementation Reports, vol. 17, no. 1, 2019, pp. 49-73.
Gasu V, Ashong M, Seferi A, et al. Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review. JBI Database System Rev Implement Rep. 2019;17(1):49-73.
Gasu, V., Ashong, M., Seferi, A., & Fitzpatrick, A. (2019). Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 17(1), 49-73. https://doi.org/10.11124/JBISRIR-2017-003740
Gasu V, et al. Effectiveness of Phosphate Binders in Adult Patients With End Stage Renal Disease Receiving Hemodialysis: a Systematic Review. JBI Database System Rev Implement Rep. 2019;17(1):49-73. PubMed PMID: 30204711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review. AU - Gasu,Vivian, AU - Ashong,Mary, AU - Seferi,Arta, AU - Fitzpatrick,Aileen, PY - 2018/9/12/pubmed PY - 2020/6/23/medline PY - 2018/9/12/entrez SP - 49 EP - 73 JF - JBI database of systematic reviews and implementation reports JO - JBI Database System Rev Implement Rep VL - 17 IS - 1 N2 - OBJECTIVES: The objective of the review was to evaluate the effectiveness of the use of phosphate binders on mortality and serum levels of phosphorus, calcium and parathyroid hormone in adult patients with end stage renal disease receiving hemodialysis compared to hemodialysis with no phosphate binder use. INTRODUCTION: End stage renal disease leading to hemodialysis is a common global health issue. Effective management of this population is focused on balancing alterations in bone mineral markers such as phosphorus, calcium and parathyroid hormone. Chronic imbalances are associated with all-cause mortality. Phosphate binders are a crucial element to regulating these levels. INCLUSION CRITERIA: The review considered studies including adult patients, age 18 and over, receiving hemodialysis. The intervention of interest was the use of any drug within the class of phosphate binders. Outcomes of interest were all-cause mortality and serum levels of phosphorus, calcium and parathyroid hormone. Experimental and quasi-experimental study designs were considered. METHODS: A search for relevant published and unpublished literature was conducted through November 5, 2017. Databases searched included PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to gray literature sources. Articles that met the inclusion criteria were further assessed for methodological validity by two independent reviewers using the standard critical appraisal instruments from Joanna Briggs Institute. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. Quantitative data were pooled for statistical meta-analysis to evaluate the impact of phosphate binders on phosphorus and calcium. RESULTS: Seven studies were included in this review. A meta-analysis of four studies showed that the use of phosphate binders resulted in a statistically significant decrease in phosphorus levels compared to placebo (mean difference -1.89 mg/dL, 95% confidence interval -2.03 mg/dL, -1.75 mg/dL); three additional studies described narratively also showed a statistically significant decrease in phosphorus. A meta-analysis of three studies showed a statistically significant increase in calcium compared to placebo (mean difference 0.57 mg/dL, 95% confidence interval 0.50 mg/dL, 0.64 mg/dL); two additional studies described narratively showed no difference in effect on calcium. Of the three studies that measured parathyroid hormone, one showed a statistically significant improvement with the use of phosphate binders (mean difference -83.0 pg/mL, 95% confidence interval -154.63 pg/mL, -11.37 pg/mL) and two showed no difference in effect. No studies measured mortality. CONCLUSION: Phosphate binders are effective in reducing serum phosphorus. The findings on parathyroid hormone and calcium did not provide adequate support for phosphate binder use. The impact on mortality was not directly measured in any of the included studies. SN - 2202-4433 UR - https://www.unboundmedicine.com/medline/citation/30204711/Effectiveness_of_phosphate_binders_in_adult_patients_with_end_stage_renal_disease_receiving_hemodialysis:_a_systematic_review_ L2 - https://doi.org/10.11124/JBISRIR-2017-003740 DB - PRIME DP - Unbound Medicine ER -