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.	李贵森. 慢性肾脏病患者高磷血症的治疗. 肾脏病与透析肾移植杂志, 2014, 23(3):248-249.
2.	许琳, 关天俊. 慢性肾脏病患者的磷管理. 世界临床药物, 2016, 37(4):236-240.
3.	陈靖, 王梦婧. 肾脏病磷代谢紊乱的机制和防治. 中华肾病研究电子杂志, 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.	杨克虎, 刘雅莉, 袁金秋, 等. 系统评价再评价的制作方法简介及相关资料分析. 中国循证儿科杂志, 2011, 6(1):58-64.
14.	杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 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.	曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统. 中国循证医学杂志, 2011, 11(9):985-990.
19.	翟春娟. 碳酸镧治疗慢性肾脏病高磷血症疗效和安全性的系统评价. 济南:山东大学, 2014.
20.	高玉春. 碳酸镧治疗维持性血液透析患者高磷血症有效性和安全性的系统评价. 中国循证医学杂志, 2006, 6(10):727-732.
21.	王世家, 陈永法. 碳酸镧治疗慢性肾衰竭并发高磷血症患者的meta分析. 中国药物经济学, 2015, 8(10):8-11.
22.	门鹏, 唐惠林, 周俊文, 等. 碳酸镧在非透析慢性肾脏病患者中的有效性和安全性的系统评价. 中国新药杂志, 2016, 25(2):193-197.
23.	张晓娟. 碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症Meta分析. 中华肾脏病杂志, 2013, 29(5):339-346.
24.	吴美延. 碳酸镧治疗终末期肾脏病高磷血症的Meta分析. 中华肾脏病杂志, 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, 刘鸣. Cochrane系统评价的基本方法. 中国临床康复, 2003, 7(4):532.
29.	安光辉, 赵毅, 姚斐, 等. 脊柱推拿治疗腰背及颈部疼痛的疗效和安全性的系统评价再评价. 中国循证医学杂志, 2015, 15(9):1010-1017.
30.	袁金秋, 刘雅莉, 杨克虎, 等. 系统评价再评价纳入研究的质量评价方法调查. 中国循证医学杂志, 2012, 12(2):238-242.
31.	张茜, 薛茜. 浅谈系统评价常见的偏倚. 循证医学, 2006, 6(2):105-108.

1. 李贵森. 慢性肾脏病患者高磷血症的治疗. 肾脏病与透析肾移植杂志, 2014, 23(3):248-249.
2. 许琳, 关天俊. 慢性肾脏病患者的磷管理. 世界临床药物, 2016, 37(4):236-240.
3. 陈靖, 王梦婧. 肾脏病磷代谢紊乱的机制和防治. 中华肾病研究电子杂志, 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. 杨克虎, 刘雅莉, 袁金秋, 等. 系统评价再评价的制作方法简介及相关资料分析. 中国循证儿科杂志, 2011, 6(1):58-64.
14. 杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 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. 曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统. 中国循证医学杂志, 2011, 11(9):985-990.
19. 翟春娟. 碳酸镧治疗慢性肾脏病高磷血症疗效和安全性的系统评价. 济南:山东大学, 2014.
20. 高玉春. 碳酸镧治疗维持性血液透析患者高磷血症有效性和安全性的系统评价. 中国循证医学杂志, 2006, 6(10):727-732.
21. 王世家, 陈永法. 碳酸镧治疗慢性肾衰竭并发高磷血症患者的meta分析. 中国药物经济学, 2015, 8(10):8-11.
22. 门鹏, 唐惠林, 周俊文, 等. 碳酸镧在非透析慢性肾脏病患者中的有效性和安全性的系统评价. 中国新药杂志, 2016, 25(2):193-197.
23. 张晓娟. 碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症Meta分析. 中华肾脏病杂志, 2013, 29(5):339-346.
24. 吴美延. 碳酸镧治疗终末期肾脏病高磷血症的Meta分析. 中华肾脏病杂志, 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, 刘鸣. Cochrane系统评价的基本方法. 中国临床康复, 2003, 7(4):532.
29. 安光辉, 赵毅, 姚斐, 等. 脊柱推拿治疗腰背及颈部疼痛的疗效和安全性的系统评价再评价. 中国循证医学杂志, 2015, 15(9):1010-1017.
30. 袁金秋, 刘雅莉, 杨克虎, 等. 系统评价再评价纳入研究的质量评价方法调查. 中国循证医学杂志, 2012, 12(2):238-242.
31. 张茜, 薛茜. 浅谈系统评价常见的偏倚. 循证医学, 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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