A meta-analysis by Palmer et al1 on the effects of phosphate binders in adults with chronic kidney disease (CKD) recently published in AJKD concluded that there is no evidence that phosphate-binder treatment reduces mortality compared to placebo. Also, Palmer et al point out that the survival benefit of sevelamer versus calcium-based binders may be attributable to a harmful effect of calcium rather than a benefit from treatment with a calcium-free phosphate binder. We believe that these conclusions are not sufficiently supported by the data and may be misinterpreted by clinical nephrologists, who could assume that there is no need to treat patients with CKD with phosphate binders.