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• W1964721805 abstract "We have concerns regarding Sophie Jamal and colleagues' Article (Oct 12, p 1268)1Jamal SA Vandermeer B Raggi P et al.Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis.Lancet. 2013; 382: 1268-1277Summary Full Text Full Text PDF PubMed Scopus (338) Google Scholar on the effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease. First, Suki and colleagues' large randomised controlled trial with 2103 patients and 542 events was a well done negative trial and should be considered while interpreting the present results.2Suki WN Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients: results of a randomized clinical trial.J Ren Nutr. 2008; 18: 91-98Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar The forest plot (figure 2)1Jamal SA Vandermeer B Raggi P et al.Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis.Lancet. 2013; 382: 1268-1277Summary Full Text Full Text PDF PubMed Scopus (338) Google Scholar strongly suggests a small-study effect;3Nuesch E Trelle S Reichenbach S et al.Small study effects in meta-analyses of osteo-arthritis trials: meta-epidemiological study.BMJ. 2010; 341: c3515Crossref PubMed Scopus (404) Google Scholar indeed a subgroup analysis of small (<50 events; RR 0·54, 95% CI 0·37–0·79) versus large (>50 events; RR 0·93, 95% CI 0·82–1·04) trials shows a significant difference in effect size. This also resolves the heterogeneity with I2 values of 0. Second, we found that the Duval's trim and fill analysis4Duval S Tweedie R Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463Crossref PubMed Scopus (7714) Google Scholar for publication bias using the correct options does add three studies with an adjusted value of the RR being 0·82 (95% CI 0·64–1·04). Lastly, the trial by Di Iorio and colleagues had a correction,5Di Iorio D Correction.http://cjasn.asnjournals.org/content/7/8/1370Google Scholar it was not registered, it was reported per protocol (and not intention-to-treat analysis) and patients were censored at dialysis inception (thus mortality after dialysis initiation was not reported) despite all cause mortality being the primary outcome. Neither the patients nor the investigators were blinded, and the categorisation of this trial5Di Iorio D Correction.http://cjasn.asnjournals.org/content/7/8/1370Google Scholar as low risk of bias is questionable. Exclusion of this trial on sensitivity analysis leads to a revised RR of 0·82 (95% CI 0·66–1·04). On the basis of these issues, the conclusion of the superiority of calcium-based phosphate binders in reducing mortality is not robust. We declare that we have no conflicts of interest. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysisNon-calcium-based phosphate binders are associated with a decreased risk of all-cause mortality compared with calcium-based phosphate binders in patients with chronic kidney disease. Further studies are needed to identify causes of mortality and to assess whether mortality differs by type of non-calcium-based phosphate binder. Full-Text PDF" @default.
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• W1964721805 date "2014-01-01" @default.
• W1964721805 modified "2023-09-27" @default.
• W1964721805 title "Calcium-based phosphate binders and chronic kidney disease" @default.
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• W1964721805 doi "https://doi.org/10.1016/s0140-6736(14)60070-2" @default.
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