Effect Of Colestilan On Hyperphosphatemia In Dialysis Patients:a Meta-analysis

Background:Hyperphosphatemia is a common complication of end-stage renal disease.Elevated blood phosphorus promotes the development of secondary hyperparathyroidism,renal osteodystrophy and metastatic calcification.Epidemiological studies have documented a significant association between hyperphosphatemia and increased mortality in patients with end-stage renal disease.Clinical strategies for the treatment of hyperphosphatemia in dialysis patients include:(1)limiting dietary phosphorus intake;(2)removing phosphate by dialysis three times per quarter or longer time;Reduce intestinal phosphate absorption by using binders.The efficacy of ordinary phosphate binders are unreliable and they are associated with a range of side effects.Aluminum-containing binders are highly effective,but widely used because of their genetic neurological,skeletal and Hematologic sticks.Magnesium-containing binders can cause gastrointestinal intolerance.Calcium-containing binders have been used as first-line treatments because they calibrate hypocalcemia in addition to lowering blood levels and are inexpensive.However,due to dose-limiting hypercalcemia and vascular calcification May not be suitable for all patients.Sevelamer is the first approved non-calcium,aluminum-free drugs,but its clinical application by the large pill load,metabolic acidosis,gastrointestinal disorders and high cost constraints;lanthanum is also true.Colestilan,A non-absorbable non-metallic anion exchange resin,traditionally used as a lipid-lowering agent.However,the recent research hotspot is its potential use as a phosphorus binder.Objective:To evaluate the efficacy and safety of colestilan as a phosphorus binder in dialysis patients,we conducted a meta-analysis of randomized controlled trials.Methods:We searched the Medline,EMBASE,Cochrane libraries,CBM,CNKI,VIP till December 2016 for the study of the use of colestilan and placebo in the treatment of dialysis patients.All language studies are included,regardless of the status of the publication.The studies were selected by two reviewers according to the inclusion and exclusion criteria,the methodological quality of the included studies was assessed.The serum phosphorus,Calcium,calcium and phosphorus products,intact parathyroid hormone,low-density cholesterol levels as the evaluation index,Meta-analysis was performed using Rev Man 5.3 software,(WMD)and its 95% confidence interval was used to describe the results.Results:A total of five articles were collected,including 1282 dialysis patients.The duration of treatment was 2 to 12 weeks,with a median of 7.5 weeks.Compared with placebo group,the levels of serum phosphorus were significantly lower in the colestilan group(WMD,-0.19 mmol / L;95% CI,-0.30 to-0.08,P = 0.001)?calcium phosphorus products were significantly lower(WMD,-0.72 mmol / L;95% CI,-1.05to-0.34,P = 0.0001)?intact PTH was significantly decreased(WMD,-5.35 pmol / L;95% CI,-8.36 to-2.35,P = 0.0005).There was no significant difference in serum calcium between the two groups.There was a significant increase of gastrointestinal disease in the colestilan group(WMD,3.45 mmol/L;95% CI,2.20 to 5.37,P<0.00001).Conclusion:Compared with the placebo group,the serum levels of phosphorus,calcium and phosphorus,parathyroid hormone and low-density cholesterol were significantly lower in the colestilan group.Current studies have shown that short-term use of colestilan can effectively treat hyperphosphatemia,but the sample size is relatively small,the follow-up time is short,the future need to have a longer duration of the larger sample study to evaluate the long-term efficacy of testlilan.