{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:57Z","timestamp":1753891977118,"version":"3.41.2"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T00:00:00Z","timestamp":1690156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006578","name":"Chi Mei Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006578","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti Library, and other major Chinese databases until 1 February 2023. The primary outcome was circulating phosphate concentration, while secondary outcomes included circulating calcium and intact parathyroid hormone levels, calcium\u2013phosphorus product, and treatment-related side-effects.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Analysis of nine studies published between 2000 and 2019 including 726 participants showed a lower circulating phosphate concentration in the cuttlebone group than in controls [mean difference (MD) = \u22120.23, 95% CI: \u22120.39 to \u22120.06, <jats:italic>p<\/jats:italic> = 0.006, I<jats:sup>2<\/jats:sup> = 94%, 726 patients] and a dose-dependent effect of cuttlebone against hyperphosphatemia. Therapeutic benefits were noted after both short-term (1\u20132\u00a0months) and long-term (3\u20136\u00a0months) treatments. Besides, patients receiving hemodialysis showed a better response to cuttlebone than those receiving peritoneal dialysis. There was no difference in circulating calcium level (mean difference = 0.03, 95% CI: \u22120.01 to 0.07, <jats:italic>p<\/jats:italic> = 0.17, I<jats:sup>2<\/jats:sup> = 34%, 654 patients), while patients receiving cuttlebone showed lower circulating iPTH level and calcium-phosphorus product (MD = \u221243.63, 95% CI: \u221274.1 to \u221213.16, <jats:italic>p<\/jats:italic> = 0.005, I<jats:sup>2<\/jats:sup> = 76%, 654 patients), (MD = \u22120.38, 95% CI: \u22120.38 to \u22120.01, <jats:italic>p<\/jats:italic> = 0.04, I<jats:sup>2<\/jats:sup> = 83%, 520 patients). No difference in the risks of constipation, gastrointestinal discomfort, and elevated blood calcium was noted between the two groups.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Compared with conventional phosphate-binding agents, cuttlebone more efficiently suppressed hyperphosphatemia with a dose-dependent effect. The limited number of included studies warrants further clinical investigations to verify our findings.<\/jats:p><jats:p><jats:bold>Systematic Review Registration:<\/jats:bold><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, identifier CRD42023396300.<\/jats:p>","DOI":"10.3389\/fphar.2023.1206366","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T09:23:27Z","timestamp":1690190607000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"14","author":[{"given":"Hsiao-Tien","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuo-Chuan","family":"Hung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chin-Wei","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jui-Yi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Cheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I-Wen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheuk-Kwan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3413","DOI":"10.3390\/ma15103413","article-title":"Marine Plankton-Derived Whitlockite Powder-Based 3D-Printed Porous Scaffold for Bone Tissue Engineering","volume":"15","author":"Baek","year":"2022","journal-title":"Mater. 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