Eight RCTs (2,873 participants) and one non-randomised study (1,377 participants) were included in the review. Validity assessment of the RCTs rated three studies as high risk, three as low risk and two as unclear.
All cause mortality: Based on the RCTs only, there was no significant difference in mortality between non calcium-based and calcium-based binders. There was some evidence of statistical heterogeneity (p=0.09; I2=47.8%). Inclusion of the non-randomised study and exclusion of one RCT did not substantially alter these results.
Cardiovascular events: Two trials showed no significant difference in cardiovascular events between non calcium-based and calcium-based binders. There was no evidence of statistical heterogeneity.
Coronary artery calcification: There was no evidence of any difference in coronary artery calcification between treatment and control groups either overall or at any specific time point (six, 12, 18 or 24 months follow-up).
The funnel plot was asymmetrical and there was a suggestion of publication bias (p=0.07).