A systematic review on the efficacy and safety of PA21 versus sevelamer in dialysis patients

To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients. We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients. Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, − 7.97 pill; 95% CI, − 11.28 to − 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, − 0.07 mmol/L; 95% CI, − 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, − 0.63 to 1.17, p = 0.55). PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.