Lanthanum Carbonate in the Treatment of Chronic Kidney Disease with Hyperphosphatemia: An Overview of Systematic Reviews_Chinese Journal of Evidence-Based Medicine

Authors：

 YUZhi-miao ¹ , NIELiu-yan ² , ZHOUQi ³ , LIYan-fen ^4,5 , ZHAOKun ² , CHANGPu ¹ , SUNYan-yan ¹ ,  PEIHong-bo ¹

1. School of Public Health of Lanzhou University, Lanzhou 730000, China;
2. The Second Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
3. Fundamentals of Lanzhou University, Lanzhou 730000, China;
4. The Second Clinical College of Northwest University for Nationalities, Lanzhou 730000, China;
5. The Second People's Hospital of Gansu Province, Lanzhou 730000, China;

Corresponding?author：

PEIHong-bo, Email: peihb@lzu.edu.cn

Keywords：

Lanthanum carbonate; Chronic kidney disease; Hyperphosphatemia; Overview of systematic reviews; AMSTAR tool; GRADE

DOI：

10.7507/1672-2531.20160211

Video：

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Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31^st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs. Results A total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low. Conclusion At present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.

Citation： YUZhi-miao, NIELiu-yan, ZHOUQi, LIYan-fen, ZHAOKun, CHANGPu, SUNYan-yan, PEIHong-bo. Lanthanum Carbonate in the Treatment of Chronic Kidney Disease with Hyperphosphatemia: An Overview of Systematic Reviews. Chinese Journal of Evidence-Based Medicine, 2016, 16(12): 1394-1400. doi: 10.7507/1672-2531.20160211 Copy

1.	李貴森. 慢性腎臟病患者高磷血癥的治療. 腎臟病與透析腎移植雜志, 2014, 23(3):248-249.
2.	許琳, 關天俊. 慢性腎臟病患者的磷管理. 世界臨床藥物, 2016, 37(4):236-240.
3.	陳靖, 王夢婧. 腎臟病磷代謝紊亂的機制和防治. 中華腎病研究電子雜志, 2014, 3(3):137-141.
4.	Bhan I, Thadhani R.Vascular calcification and ESRD:a hard target. Clin J Am Soc Nephrol, 2009, 4 Suppl:S102-S105.
5.	Moe S, Drueke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11):1945-1953.
6.	Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium,phosphorus, and PTH:the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3):519-530.
7.	Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality,and morbidity in maintenance hemodialysis. J Am Soc Nephrol, 2004, 15(8):2208-2218.
8.	Albaaj F, Hutchison A. Hyperphosphataemia in renal failure:causes, consequences and current management. Drugs, 2003, 63(6):577-596.
9.	Indridason OS, Quarles LD. Hyperphosphatemia in end-stage renal disease. Adv Ren Replace The, 2002, 9(3):184-192.
10.	Yamada K, Fujimoto S, Nishiura R, et al. Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant, 2007, 22(7):2032-2037.
11.	Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int, 2005, 68(4):1815-1824.
12.	Locatelli F, D'Amico M, Pontoriero G. Lanthanum carbonate (Shire). IDrugs, 2003, 6(7):688-695.
13.	楊克虎, 劉雅莉, 袁金秋, 等. 系統評價再評價的制作方法簡介及相關資料分析. 中國循證兒科雜志, 2011, 6(1):58-64.
14.	楊克虎, 劉雅莉, 袁金秋, 等. 發展和完善中的系統評價再評價. 中國循證兒科雜志, 2011, 6(1):54-57.
15.	Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classifi-cation of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int, 2005, 67(6):2089-2100.
16.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7(1):10.
17.	GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454):1490.
18.	曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用GRADE系統. 中國循證醫學雜志, 2011, 11(9):985-990.
19.	翟春娟. 碳酸鑭治療慢性腎臟病高磷血癥療效和安全性的系統評價. 濟南:山東大學, 2014.
20.	高玉春. 碳酸鑭治療維持性血液透析患者高磷血癥有效性和安全性的系統評價. 中國循證醫學雜志, 2006, 6(10):727-732.
21.	王世家, 陳永法. 碳酸鑭治療慢性腎衰竭并發高磷血癥患者的meta分析. 中國藥物經濟學, 2015, 8(10):8-11.
22.	門鵬, 唐惠林, 周俊文, 等. 碳酸鑭在非透析慢性腎臟病患者中的有效性和安全性的系統評價. 中國新藥雜志, 2016, 25(2):193-197.
23.	張曉娟. 碳酸鑭與傳統磷結合劑治療維持性血液透析患者高磷血癥Meta分析. 中華腎臟病雜志, 2013, 29(5):339-346.
24.	吳美延. 碳酸鑭治療終末期腎臟病高磷血癥的Meta分析. 中華腎臟病雜志, 2013, 29(6):406-412.
25.	Huang W, Liu J, Tang Y, et al. Efficacy and Tolerability of Lanthanum Carbonate in Treatment of Hyperphosphatemia Patients Receiving Dialysis——A Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Med Res Opin, 2014, 30(1):99-108.
26.	Guo H, Zhang X, Tang S, et al. Effects and safety of lanthanum carbonate in end stage renal disease patients with hyperphosphatemia:a meta-analysis——system review of lanthanum carbonate. Renal Failure, 2013, 35(10):1455-1464.
27.	Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med, 2010, 362(14):1312-1324.
28.	屈云, 何俐, 劉鳴. Cochrane系統評價的基本方法. 中國臨床康復, 2003, 7(4):532.
29.	安光輝, 趙毅, 姚斐, 等. 脊柱推拿治療腰背及頸部疼痛的療效和安全性的系統評價再評價. 中國循證醫學雜志, 2015, 15(9):1010-1017.
30.	袁金秋, 劉雅莉, 楊克虎, 等. 系統評價再評價納入研究的質量評價方法調查. 中國循證醫學雜志, 2012, 12(2):238-242.
31.	張茜, 薛茜. 淺談系統評價常見的偏倚. 循證醫學, 2006, 6(2):105-108.

1. 李貴森. 慢性腎臟病患者高磷血癥的治療. 腎臟病與透析腎移植雜志, 2014, 23(3):248-249.
2. 許琳, 關天俊. 慢性腎臟病患者的磷管理. 世界臨床藥物, 2016, 37(4):236-240.
3. 陳靖, 王夢婧. 腎臟病磷代謝紊亂的機制和防治. 中華腎病研究電子雜志, 2014, 3(3):137-141.
4. Bhan I, Thadhani R.Vascular calcification and ESRD:a hard target. Clin J Am Soc Nephrol, 2009, 4 Suppl:S102-S105.
5. Moe S, Drueke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11):1945-1953.
6. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium,phosphorus, and PTH:the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3):519-530.
7. Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality,and morbidity in maintenance hemodialysis. J Am Soc Nephrol, 2004, 15(8):2208-2218.
8. Albaaj F, Hutchison A. Hyperphosphataemia in renal failure:causes, consequences and current management. Drugs, 2003, 63(6):577-596.
9. Indridason OS, Quarles LD. Hyperphosphatemia in end-stage renal disease. Adv Ren Replace The, 2002, 9(3):184-192.
10. Yamada K, Fujimoto S, Nishiura R, et al. Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant, 2007, 22(7):2032-2037.
11. Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int, 2005, 68(4):1815-1824.
12. Locatelli F, D'Amico M, Pontoriero G. Lanthanum carbonate (Shire). IDrugs, 2003, 6(7):688-695.
13. 楊克虎, 劉雅莉, 袁金秋, 等. 系統評價再評價的制作方法簡介及相關資料分析. 中國循證兒科雜志, 2011, 6(1):58-64.
14. 楊克虎, 劉雅莉, 袁金秋, 等. 發展和完善中的系統評價再評價. 中國循證兒科雜志, 2011, 6(1):54-57.
15. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classifi-cation of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO). Kidney Int, 2005, 67(6):2089-2100.
16. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7(1):10.
17. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454):1490.
18. 曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用GRADE系統. 中國循證醫學雜志, 2011, 11(9):985-990.
19. 翟春娟. 碳酸鑭治療慢性腎臟病高磷血癥療效和安全性的系統評價. 濟南:山東大學, 2014.
20. 高玉春. 碳酸鑭治療維持性血液透析患者高磷血癥有效性和安全性的系統評價. 中國循證醫學雜志, 2006, 6(10):727-732.
21. 王世家, 陳永法. 碳酸鑭治療慢性腎衰竭并發高磷血癥患者的meta分析. 中國藥物經濟學, 2015, 8(10):8-11.
22. 門鵬, 唐惠林, 周俊文, 等. 碳酸鑭在非透析慢性腎臟病患者中的有效性和安全性的系統評價. 中國新藥雜志, 2016, 25(2):193-197.
23. 張曉娟. 碳酸鑭與傳統磷結合劑治療維持性血液透析患者高磷血癥Meta分析. 中華腎臟病雜志, 2013, 29(5):339-346.
24. 吳美延. 碳酸鑭治療終末期腎臟病高磷血癥的Meta分析. 中華腎臟病雜志, 2013, 29(6):406-412.
25. Huang W, Liu J, Tang Y, et al. Efficacy and Tolerability of Lanthanum Carbonate in Treatment of Hyperphosphatemia Patients Receiving Dialysis——A Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Med Res Opin, 2014, 30(1):99-108.
26. Guo H, Zhang X, Tang S, et al. Effects and safety of lanthanum carbonate in end stage renal disease patients with hyperphosphatemia:a meta-analysis——system review of lanthanum carbonate. Renal Failure, 2013, 35(10):1455-1464.
27. Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med, 2010, 362(14):1312-1324.
28. 屈云, 何俐, 劉鳴. Cochrane系統評價的基本方法. 中國臨床康復, 2003, 7(4):532.
29. 安光輝, 趙毅, 姚斐, 等. 脊柱推拿治療腰背及頸部疼痛的療效和安全性的系統評價再評價. 中國循證醫學雜志, 2015, 15(9):1010-1017.
30. 袁金秋, 劉雅莉, 楊克虎, 等. 系統評價再評價納入研究的質量評價方法調查. 中國循證醫學雜志, 2012, 12(2):238-242.
31. 張茜, 薛茜. 淺談系統評價常見的偏倚. 循證醫學, 2006, 6(2):105-108.

Chinese Journal of Evidence-Based Medicine

Lanthanum Carbonate in the Treatment of Chronic Kidney Disease with Hyperphosphatemia: An Overview of Systematic Reviews

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