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This research evaluates the effectiveness and safety of various phosphorus-lowering drugs in adults with chronic kidney disease (CKD) stages 3-5.

March 16, 2026Kidney Medicine0 citationsOpen Access

Comparative Effectiveness and Safety of Phosphorus-Lowering Drugs for CKD Stages 3-5

WHWenping Hou PXPeitao XieInner Mongolia People's Hospital YFYa FuInner Mongolia People's Hospital

Key Points

This research evaluates the effectiveness and safety of various phosphorus-lowering drugs in adults with chronic kidney disease (CKD) stages 3-5.
Conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs)
Reviewed 121 RCTs involving 18,376 subjects and 12 phosphorus-lowering drugs
Performed subgroup analyses for dialysis and non-dialysis patients
Used Cochrane RoB 2 tool to assess risk of bias.
Most drugs lowered serum phosphorus levels except SFC
PA21, NA, and TE ranked best for efficacy
Calcium-based drugs posed higher risks for hypercalcemia compared to CaMg, NA, and CO
All drugs significantly affected serum iPTH levels
Iron-containing drugs improved iron parameters.

Abstract

Objective: To evaluate the efficacy and safety of 12 phosphorus-lowing drugs for hyperphosphatemia in chronic kidney disease (CKD) stages 3-5.Study Design Unclear allocation concealment and blinding; Low evidence quality reduced reliability.Conclusions: PA21 has the best phosphorus-lowering effect in hyperphosphatemia adults with CKD; considering efficacy and safety, CC shows evidence to be the most J o u r n a l P r e -p r o o f appropriate drug with or without dialysis.

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