| Summary: | Introduction and objectives: Calcium and phosphate metabolism is impaired in hemodialysis patients with chronic kidney disease (CKD). Therefore, it can lead to calcification of tissues, bone disease and secondary hyperparathyroidism. Increased levels of these composites can be associated with an enhanced cardiovascular (CV) and overall mortality. The aim of this review and subsequent meta-analysis is to compare the outcomes of two classes of phosphate binders on hemodialysis patients. Methods: Randomized control trials (RCTs) published on PubMed, SCOPUS and Web of Science comparing non-calcium-based phosphate binders (NCBPBs) with other calcium-based phosphate binders (CBPBs) in adults undergoing hemodialysis were systematically identified. Results: We found 14 studies that included a total of 6173 participants. NCBPBs showed a risk reduction in all-cause mortality with a follow-up ≤36 months (relative risk (RR) 0.21, 95% confidence interval (CI) 0.23 to 0.45, p <0.00001, I2 = 14%) comparing with CBPBs. Meta-analysis considering coronary artery calcium score (CACS) demonstrated a significantly smaller increase in participants treated with NCBPBs in comparison with CBPBs (mean difference (MD) - 76.24, 95% CI -126.17 to -26.31, p=0.003, I2 = 18%). The same was found in the subanalysis of data with a follow-up> 12 months (MD -101.38; 95% CI - 175.66 to -27.09, p=0.007, I2= 32). Meta-analysis of CV mortality, serum levels of phosphorus, calcium and iPTH did not show any statistical significance result. Conclusions: NCBPBs showed a smaller increase in coronary artery calcification and lower risk of all-cause mortality with a follow-up inferior or equal of 36 months in comparison to CBPBs.
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