Meta-Analysis of the Differences in Effectiveness and Safety of Iron-Based Phosphate Binders and Non-Calcium Phosphate Binders

Introduction: Iron-based phosphate binders are a new therapy for Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD). Currently, the commonly used iron-based phosphate binders in clinical practice are of two types: sucroferric oxyhydroxide (SFOH) and ferric citrate (FC). This study aimed to examine randomized controlled clinical trials of SFOH and FC for the treatment of CKD patients, as part of a systematic review and meta-analysis. Methods: The databases of Medline (PubMed), Web of Science, Embase, and the Cochrane Library were searched for relevant literature published from the inception of the databases to February 25th, 2025. The effectiveness and safety of iron-based phosphate binders and non-calcium phosphate binders were analyzed and compared. Results: The phosphate reduction effect of iron-based phosphate binders in CKD patients demonstrated no significant difference from that of non-calcium phosphate binders. Iron-based phosphate binders can achieve the same phosphate-reducing effect at lower doses and increase serum ferritin and hemoglobin levels. However, iron-based phosphate binders increase the incidence of gastrointestinal adverse events, mainly diarrhea and changes in stool color. Discussion: This study demonstrated the absolute advantage of iron-based phosphorus binders in terms of medication load. Additionally, they were also found to improve anemia. This study did not analyze the effects of different drug dose subgroups on calcium and phosphorus metabolism, so it was impossible to determine whether iron-based phosphorus binders achieved greater reductions in phosphorus at the same dose. Conclusion: Compared with non-calcium-based phosphate binders, iron-based phosphate binders have a lower medication burden and can improve anemia, but increase the incidence of overall gastrointestinal adverse events.