枸橼酸铁治疗慢性肾脏病高磷血症疗效及安全性的Meta分析

Efficacy and safety offerric citrate in treatment of hyperphosphatemia in patients with chronic kidney disease:a Meta-analysis

目的评价枸橼酸铁治疗慢性肾脏病(chronic kidney disease,CKD)高磷血症的疗效及安全性,为临床用药提供循证依据。方法计算机检索Cochrane图书馆、Pubmed、EMBase、Web of Science数据库,收集并整理关于枸橼酸铁治疗CKD高磷血症的随机对照试验(randomized controlled trial,RCT)文献,使用RevMan5.3统计软件进行Meta分析,比较枸橼酸铁与安慰剂或其他磷结合剂治疗CKD高磷血症的疗效和安全性差异。结果纳入了11项RCT,共计1906例患者。Meta分析结果显示与对照组相比,枸橼酸铁降磷效果更佳[MD=-0.66,95%CI(-0.77,-0.55),P<0.01],其中与安慰剂相比,枸橼酸铁可降低CKD高磷血症患者的血磷[MD=-0.97,95%CI(-1.10,-0.84),P<0.01],而与其他磷结合剂比较其降磷作用亦不逊色[MD=0.10,95%CI(-0.11,0.30),P=0.36]。此外,枸橼酸铁升高CKD患者的血红蛋白、铁蛋白、转铁蛋白饱和度及血细胞比容水平。在不良反应方面,与安慰剂或其他磷结合剂相比,枸橼酸铁组的腹泻发生率更高,便秘和腹胀发生率则在两组之间差异无统计学意义。结论枸橼酸铁可有效降低CKD高磷血症患者的血磷,并同时改善肾性贫血。

Objective To evaluate the efficacy and safety of ferric citrate in treatment of hyperphosphatemia in patients with chronic kidney disease(CKD),and provide evidence-based basis for clinical medication.Methods The literature on randomized controlled trials(RCTs)relating to treatment of hyperphosphatemia in patients with CKD was searched from the databases of Cochrane Library,PubMed,EMBase,and Web of Science.We used software RevMan5.3 to perform the Meta-analysis of the included RCTs to compare the efficacy and safety of ferric citrate versus placebo or other phosphorus binding agents in treatment of hyperphosphatemia in patients with CKD.Results A total of 1906 cases in 11 RCTs was included.Our meta-analysis showed that,compared to the control group,ferric citrate did better in alleviating hyperphosphatemia[MD=-0.66,95%CI(-0.77,-0.55),P<0.01],where it reduced serum phosphorus compared with placebo[MD=-1.43,95%CI(-2.20,-0.66),P<0.01]and was not inferior to other phosphorus binders[MD=0.10,95%CI(-0.11,0.30),P=0.36].Furthermore,ferric citrate significantly improved hemoglobin,ferritin,transferrin saturation and hematocrit.In terms of adverse effects,compared with the placebo group or other phosphorus binder groups,in the ferric citrate group the incidence of diarrhea was higher and the incidence of constipation and bloating did not differ significantly between ferric citrate and placebo groups or other phosphorus binder groups.Conclusions Ferric citrate can effectively reduce serum phosphorus in patients with CKD and hyperphosphatemia,and also improve renal anemia.