Steven Habbous

The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis

Background. It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD). Methods. We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD. Results. Fifty-one trials (8829 patients) were reviewed. Compared with calcium-based binders, all-cause mortality was nonsignificantly lower with sevelamer {risk ratio [RR] 0.62 [95% confidence interval (CI) 0.35–1.08]} and lanthanum [RR 0.73 (95% CI 0.18–3.00)], but risk of bias was concerning. Compared with calcium-based binders, sevelamer reduced the risk of hypercalcemia [RR 0.27 (95% CI 0.17–0.42)], as did lanthanum [RR 0.12 (95% CI 0.05–0.32)]. Sevelamer reduced hospitalizations [RR 0.50 (95% CI 0.31–0.81)], but not lanthanum [RR 0.80 (95% CI 0.34–1.93)]. The presence/absence of other clinically relevant outcomes was infrequently reported. Compared with calcium-based binders, sevelamer reduced serum calcium, low-density lipoprotein and coronary artery calcification, but increased intact parathyroid hormone. The clinical relevance of these changes is unknown since corresponding clinical outcomes were not reported. Lanthanum had less favorable impact on biochemical parameters. Sevelamer hydrochloride and sevelamer carbonate were similar in three studies. Sevelamer was similar to lanthanum (three studies) and iron-based binders (three studies). Conclusion. Sevelamer was associated with a nonsignificant reduction in mortality and significantly lower hospitalization rates and hypercalcemia compared with calcium-based binders. However, differences in important outcomes, such as cardiac events, fractures, calciphylaxis, hyperchloremic acidosis and health-related quality of life remain understudied. Lanthanum and iron-based binders did not show superiority for any clinically relevant outcomes. Future studies that fail to measure clinically important outcomes (the reason why phosphate binders are prescribed in the first place) will be wasteful.

Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications

Purpose of ReviewAn inefficient living donor candidate evaluation process can be a barrier to timely living donor transplantation and optimal donor satisfaction. In this review, we examine the inefficiencies of the living kidney donor evaluation and make recommendations to optimize this process.Recent FindingsThere is increasing awareness that the living donor evaluation process is inefficient, but little research has been done to date. The time to complete the evaluation can be several or even many months. Avoidable delays can lead to dialysis initiation for pre-emptive transplant candidates, lengthen dialysis time for those patients on dialysis, and reduce donor satisfaction. Opportunities to improve efficiency include the choice, timing, sequencing of evaluation tests, procedures and consults, use of navigators, and monitoring of evaluation timeliness as a quality metric.SummaryA more efficient evaluation is expected to result in better health outcomes for patients with kidney failure and incur substantial cost savings to the healthcare system.

Potential implications of a more timely living kidney donor evaluation

Living donor kidney transplantation is the most promising way to avoid or minimize the amount of time a recipient spends on dialysis before transplantation. We studied 887 living kidney donors at 5 transplant centers in Ontario, Canada, who started their evaluation and donated between April 2006 and March 2014. Using a series of hypothetical scenarios, we estimated the impact of an earlier living donor evaluation completion and donation on the number pre‐emptive transplants, the time spent on dialysis, healthcare cost savings from averted dialysis costs (CAD

Cost-Effectiveness of First-Line Sevelamer and Lanthanum versus Calcium-Based Binders for Hyperphosphatemia of Chronic Kidney Disease

2016), and the number of additional transplants. During the study period, if the donor transplants occurred 3 months earlier, the healthcare system would save on average

Initiating maintenance dialysis prior to living kidney donor transplantation when a donor candidate evaluation is well underway

12 055 (standard deviation [SD]

Duration of Living Kidney Transplant Donor Evaluations: Findings From 2 Multicenter Cohort Studies

13 594) per recipient; 21 recipients could have avoided dialysis altogether, and 57 additional transplants (a 26% increase) could have occurred each year. For the 220 living kidney donor transplants performed in Ontario, Canada, each year, this translates to a total annual cost savings of

The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review

2.7M. In conclusion, a more timely evaluation of living donor candidates and their intended recipients may increase the supply of kidneys for transplantation. Improved evaluation efficiency may also yield more pre‐emptive transplants and substantial healthcare cost savings through averted dialysis costs.

Healthcare Costs for the Evaluation, Surgery, and Follow-Up Care of Living Kidney Donors

BACKGROUND Phosphate binders are used to treat hyperphosphatemia among patients with chronic kidney disease (CKD). OBJECTIVES To conduct an economic evaluation comparing calcium-free binders sevelamer and lanthanum with calcium-based binders for patients with CKD. METHODS Effectiveness data were obtained from a recent meta-analysis of randomized trials. Effectiveness was measured as life-years gained and translated to quality-adjusted life-years (QALYs) using utility weights from the literature. A Markov model consisting of non-dialysis-dependent (NDD)-CKD, dialysis-dependent (DD)-CKD, and death was developed to estimate the incremental costs and effects of sevelamer and lanthanum versus those of calcium-based binders. A lifetime horizon was used and both costs and effects were discounted at 1.5%. All costs are presented in 2015 Canadian dollars from the Canadian public payer perspective. Results of probabilistic sensitivity analysis were presented using cost-effectiveness acceptability curves. Sensitivity analyses were conducted for risk pooling methods, omission of dialysis costs, and persistence of drug effects on mortality. RESULTS Sevelamer resulted in an incremental cost-effectiveness ratio of

Appraisal of a redundant report on lanthanum carbonate.

106,522/QALY for NDD-CKD and

Gestational hypertension and preeclampsia in living kidney donors

133,847/QALY for DD-CKD cohorts. Excluding dialysis costs, sevelamer was cost-effective in the NDD-CKD cohort (