The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials

Background: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear. Methods: Randomized controlled trials comparing the conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti other major Chinese databases until 1 February 2023. primary outcome was circulating phosphate concentration, while secondary outcomes included calcium intact parathyroid hormone levels, calcium–phosphorus product, treatment-related side-effects. Results: Analysis nine studies published between 2000 2019 including 726 participants showed a lower concentration group than controls [mean difference (MD) = −0.23, 95% CI: −0.39 to −0.06, p 0.006, I 2 94%, patients] dose-dependent effect against hyperphosphatemia. Therapeutic benefits noted after both short-term (1–2 months) long-term (3–6 treatments. Besides, receiving hemodialysis better response those peritoneal dialysis. There no level (mean 0.03, −0.01 0.07, 0.17, 34%, 654 patients), iPTH calcium-phosphorus product (MD −43.63, −74.1 −13.16, 0.005, 76%, −0.38, −0.38 −0.01, 0.04, 83%, 520 patients). No risks constipation, gastrointestinal discomfort, elevated blood two groups. Conclusion: Compared phosphate-binding agents, more efficiently suppressed effect. limited number warrants further clinical investigations verify our findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42023396300.