Meta-analysis comparing sevelamer and calcium-based phosphate binders on cardiovascular calcification in hemodialysis patients.

BACKGROUND: Accelerated cardiovascular calcification often occurs in patients with cardiovascular disease who are on hemodialysis. We performed a meta-analysis to compare the effects of sevelamer hydrochloride and calcium-based phosphate binders on coronary artery calcification, C-reactive protein, alkaline phosphatase and intact parathyroid hormone in patients undergoing hemodialysis.

METHODS: We used the key words 'sevelamer' and 'Renagel' to retrieve studies from Medline, the Cochrane Library and conference proceedings. The trials searched were evaluated for eligibility and quality, and then the data were abstracted and analyzed.

RESULTS: We ultimately included 14 studies that enrolled a total of 3,271 patients. There was no difference in coronary artery calcium progression between the calcium and the sevelamer groups. Use of sevelamer, rather than calcium-based phosphate binders, was associated with significantly lower C-reactive protein levels (weighted mean difference (WMD) -1.42; 95% confidence interval (CI) -2.09 to -0.74), higher alkaline phosphatase levels (WMD 22.66; 95% CI 13.81-31.5) and higher intact parathyroid hormone levels (WMD 55.85; 95% CI 14.47-97.24).

CONCLUSIONS: Treatment with sevelamer did not affect cardiovascular calcification, but there was a trend for lower C-reactive protein levels, higher alkaline phosphatase levels and intact parathyroid hormone levels among sevelamer-treated patients.