Lioufas N, Pascoe E, Hawley C, et al. - Non-calcium-based phosphate-lowering therapy for non-dialysis chronic kidney disease (CKD) led to reduction in serum phosphate and urinary phosphate excretion, however, there was an unclear impact on clinical results and intermediate cardiovascular endpoints.

• Randomized controlled trials (n=20; 2,498 participants) that reported outcomes of noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant, were included in this meta-analysis.

• Reduction in serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, standardized mean differences [SMD] -0.61, 95% CI -0.90,-0.31, low certainty evidence) was afforded by non calcium-based phosphate binders vs placebo.

• Relative to placebo, non calcium-based phosphate binders led to increased constipation (9 trials, log odds ratio [OR] 0.93) and greater vascular calcification score (3 trials, SMD 0.47).

• Scant data exist on impacts of phosphate-lowering therapy on cardiovascular events (log OR 0.51) and death.