Sevelamer 800mg oral powder sachets sugar free

IntroductionPhosphate binders are commonly used in patients receiving kidney replacement therapy (KRT), aiming to reduce and maintain serum phosphorus. Chronic kidney disease-mineral and bone disorder has been linked to reduced lifespan and worsened quality of life. This study aims to examine the efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate in patients receiving KRT.MethodsThe data sources examined were MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Clinical Trials with a search deadline of October 2023. We examined randomized controlled trials that compared sucroferric oxyhydroxide versus sevelamer carbonate in the adult population receiving KRT. We performed a meta-analysis combining the data from trials, using R-studio.FindingsInclusion criteria were met by five randomized trials. There was no statistically significant difference in the reduction of serum phosphorus between the two groups (MD: -0.07 mmol/L, 95% CI-random effects: -0.15 to 0.02). In the same line, a non-statistically significant difference was observed in serum i-PTH reduction between the two drugs (MD = -1.53 mg/dL, 95% CI = (-4.45, 1.4), p = 0.26, random effects model). No statistically significant difference was observed in all adverse events between the two groups (odds ratio: 1.11, 95% CI: 0.65-1.88, random effects model). Further analysis of gastrointestinal adverse events revealed that sevelamer carbonate increases gastrointestinal adverse events by up to 60% (odds ratio: 1.60, 95% CI: 1.31-1.97, common (fixed) effect model).DiscussionThis meta-analysis of randomized trials showed that both drugs, sucroferric oxyhydroxide and sevelamer equally and effectively controlled serum phosphorus levels, whereas sucroferric oxyhydroxide revealed a better profile in terms of gastrointestinal adverse events. Sucroferric oxyhydroxide is a valuable option for patients receiving KRT when sevelamer carbonate is more difficult to tolerate.

Abstract licence: CC BY-NC-ND

BACKGROUND: Phosphate binders are used to manage hyperphosphatemia in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and may influence fibroblast growth factor 23 (FGF-23), a biomarker associated with disease progression and mortality. However, the comparative effects of calcium-based phosphate binders (CPBs) and non-calcium-based phosphate binders (NCPBs) on FGF-23 levels remain unclear. We conducted a meta-analysis of randomized controlled trials to compare the effects of NCPBs and CPBs on FGF-23 levels in patients with CKD-MBD with hyperphosphatemia. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Library was performed for studies published up to August 2024. Only randomized controlled trials were eligible; non-randomized controlled trials, studies with overlapping patient populations, pediatric or animal studies, and trials without quantitative FGF-23 outcomes were excluded. Language restrictions were not imposed. Data were synthesized as standardized mean differences using a random-effects model, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool. RESULTS: Eleven randomized controlled trials involving 791 patients were included. Overall, NCPBs were associated with a greater reduction in FGF-23 levels compared with CPBs (standardized mean difference −0.56, 95% confidence interval −0.95 to −0.17, p = 0.005). Subgroup analyses suggested consistent trends across binder types (sevelamer and lanthanum), dialysis status, and treatment duration. However, the subgroup differences were not statistically significant, and heterogeneity remained substantial in several subgroups, indicating that these findings should be interpreted with caution. CONCLUSIONS: In CKD-MBD patients with hyperphosphatemia, NCPBs were associated with greater reductions in FGF-23 levels compared with CPBs. The subgroup results suggested possible trends by binder type, CKD category, and treatment duration. However, given the heterogeneity and lack of statistically significant subgroup differences, these findings should be considered hypothesis-generating. Further well-designed trials are needed to confirm these results and clarify the underlying mechanisms and clinical implications.

Abstract licence: CC BY-NC-ND