Calcium-Based vs. Non–Calcium-Based Phosphate Binders in Patients with Chronic Kidney Disease

Hyperphosphatemia in patients with chronic kidney disease is associated with excess cardiovascular-related mortality and usually is treated or prevented with phosphate binders. Some studies suggest that calcium-based binders (e.g., calcium carbonate) are associated with risk for vascular calcification and premature death. However, whether non–calcium-based binders such as sevelamer (Renagel, Renvela) and lanthanum (Fosrenol) are safer or more effective is unclear, and recommendations from experts vary. A 2009 meta-analysis of eight randomized controlled trials showed a trend toward later mortality among patients who took non–calcium-based binders, but the study lacked statistical power. Now, in an expanded meta-analysis, the authors have as…