Evidence

Evidence tables

This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.


Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be less effective or likely to be more harmful than the comparison for key outcomes.


Population: Pre-dialysis or dialysis adults with hyperphosphatemic CKD ᵃ

Intervention: Calcium-containing phosphate binders

Comparison: Calcium-free phosphate binders

OutcomeEffectiveness (BMJ rating)?Confidence in evidence (GRADE)?

Mortality

Favors comparison

Moderate

Cardiovascular and cerebrovascular events

See note ᵇ

Low

Recommendations as stated in the source guideline

The 2017 Kidney Disease Improving Global Outcomes (KDIGO) guideline on CKD-MBD makes the following recommendation:

In adult patients with CKD (GFR category) G3a–G5D receiving phosphate-lowering treatment, we suggest restricting the dose of calcium-based phosphate binders (weak recommendation; moderate-quality evidence).

Note

ᵃ Population as reported by the guideline.

ᵇ The guideline reported results for this outcome narratively due to inconsistent results across studies. See guideline for more information.

This evidence table is related to the following section/s:

This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.


Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future. 


Population: People with CKD G3a-G5 or G5D

Intervention: Lower concentrations of serum phosphate or calcium

Comparison: Higher concentrations of serum phosphate or calcium

OutcomeEffectiveness (BMJ rating)?Confidence in evidence (GRADE)?

Serum phosphate

Mortality

Favors intervention

Low

Glomerular Filtration Rate (GFR) decline

See note ᵃ

Very Low

Cardiovascular and cerebrovascular events

See note ᵇ

Very Low

Serum calcium

Mortality

Favors intervention

Low

Cardiovascular and cerebrovascular events

Favors intervention

Low

Recommendations as stated in the source guideline

The 2017 Kidney Disease Improving Global Outcomes (KDIGO) guideline on CKD-MBD makes the following recommendations:

  • In patients with CKD (GFR category) G3a–G5D, treatments of CKD-MBD should be based on serial assessments of phosphate, calcium, and parathyroid hormone (PTH) levels, considered together (not graded).

  • In people with CKD G3a-G5D, we suggest lowering elevated phosphate levels toward the normal range (weak recommendation; low-quality evidence).

  • In adult patients with CKD G3a–G5D, we suggest avoiding hypercalcemia (weak recommendation; low-quality evidence).

  • In patients with CKD G3a–G5D, it is reasonable to base the frequency of monitoring serum calcium, phosphate, and PTH on the presence and magnitude of abnormalities, and the rate of progression of CKD (not graded).ᶜ

Note

The guideline only identified evidence from observational studies to answer this clinical question.

ᵃ Reported as inconclusive based on indirect evidence from 8 observational studies (N=3755).

ᵇ Reported as inconclusive based on direct evidence from 7 observational studies (N=34231).

ᶜ The guideline group also recommended reasonable monitoring intervals (not graded). See guideline for more information.

This evidence table is related to the following section/s:

Cochrane Clinical Answers

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