{"title":"西维拉默对慢性肾病及血液透析患者血清磷水平的影响系统回顾和荟萃分析","authors":"Farshad Gharebakhshi, Mohammad Hossein Taklif, Arash Izadpanah Ghahremani, Mohamad Khaledi, Sara Abbasian, Seyedeh Mahsa Shariati Sough, Fatemeh Vashahi Torfi, Hamidreza Khodabandeh, Elnaz Hajian","doi":"10.34172/jnp.2023.21463","DOIUrl":null,"url":null,"abstract":"Introduction: Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients. Objectives: This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients. Materials and Methods: The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values < 0.05 were considered significant. Findings: A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05). Conclusion: The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023406804).","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of sevelamer on serum phosphorus levels in chronic kidney disease and hemodialysis patients; a systematic review and meta-analysis\",\"authors\":\"Farshad Gharebakhshi, Mohammad Hossein Taklif, Arash Izadpanah Ghahremani, Mohamad Khaledi, Sara Abbasian, Seyedeh Mahsa Shariati Sough, Fatemeh Vashahi Torfi, Hamidreza Khodabandeh, Elnaz Hajian\",\"doi\":\"10.34172/jnp.2023.21463\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients. Objectives: This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients. Materials and Methods: The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values < 0.05 were considered significant. Findings: A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05). Conclusion: The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. 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引用次数: 0
摘要
引言：高磷酸盐血症是慢性肾脏病（CKD）患者死亡的独立危险因素。目的：本系统综述和荟萃分析旨在研究司维拉姆对CKD和血液透析患者血清磷水平的影响。材料和方法：数据是在搜索Cochrane、PubMed、Scopus、Web of Science和Google Scholar搜索引擎的国际数据库后获得的，直到2023年2月28日。文章的异质性使用I2指数进行评估。数据在STATA14中进行分析，P值<0.05被认为是显著的。研究结果：共评估了22篇文章，总样本量为3221。与对照组相比，司维拉姆降低了CKD和血液透析患者的钙水平（标准化平均差异[SMD]：-0.67；95%可信区间：-1.23，-0.11）；然而，司维拉姆对血清甲状旁腺激素（PTH）水平（SMD:0.07；95%CI:0.39,0.54）和Ca×P产物（SMD:-0.20；95%CI-0.41,0）没有显著影响。与对照组相比，服用司维拉姆最多12周的患者血清磷水平显著下降（SMD:-0.27；95%CI:-0.54，-0.01）；然而，在服用司维拉姆超过12周的患者中，没有观察到血清磷水平的显著下降。与安慰剂组成员相比，司维拉姆使用者的血清磷水平显著降低（SMD:-0.36；95%可信区间：-0.68，-0.05）。结论：与安慰剂组相比，短期内服用司维拉姆降低了CKD和血液透析患者的血磷水平。因此，建议医生给司维拉姆开最长三个月的处方。注册：本研究基于PRISMA检查表编制，其方案已在PROSPERO网站（ID:CRD42023406804）上注册。
Effect of sevelamer on serum phosphorus levels in chronic kidney disease and hemodialysis patients; a systematic review and meta-analysis
Introduction: Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients. Objectives: This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients. Materials and Methods: The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values < 0.05 were considered significant. Findings: A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05). Conclusion: The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023406804).
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