Use of phosphate-binding agents is associated with a lower risk of mortality
CHRONIC KIDNEY-DISEASE
Male
Time Factors
SEVELAMER HYDROCHLORIDE
Chelating Agents/therapeutic use
hyperparathyroidism
Phosphates/blood
0302 clinical medicine
Risk Factors
info:eu-repo/classification/ddc/616
10035 Clinic for Nephrology
Prospective Studies
Biological Markers/blood
VITAMIN-D
Chelating Agents
ddc:616
Aged, 80 and over
2727 Nephrology
Cardiovascular Diseases/diagnosis/mortality/prevention & control
Hyperphosphatemia/blood/diagnosis/drug therapy/mortality
Middle Aged
SECONDARY HYPERPARATHYROIDISM
Renal Insufficiency, Chronic/blood/diagnosis/mortality/therapy
mineral metabolism
3. Good health
Europe
Hyperphosphatemia
Treatment Outcome
Nephrology
Cardiovascular Diseases
Female
PRACTICE PATTERNS
Renal Dialysis/adverse effects/mortality
RENAL-FAILURE
dialysis; hyperparathyroidism; hyperphosphatemia; mineral metabolism; mortality risk; phosphate binders
610
610 Medicine & health
CALCIUM
Europe/epidemiology
Phosphates
03 medical and health sciences
VASCULAR CALCIFICATION
Renal Dialysis
616
phosphate binders
Humans
Renal Insufficiency, Chronic
hyperphosphatemia
Propensity Score
Aged
Proportional Hazards Models
Chi-Square Distribution
DIALYSIS PATIENTS
Multivariate Analysis
EUROPEAN HEMODIALYSIS POPULATION
dialysis
mortality risk
Dialysis
Biomarkers
DOI:
10.1038/ki.2013.185
Publication Date:
2013-07-03T12:39:09Z
AUTHORS (27)
ABSTRACT
Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix-adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models. Three different multivariate models that included up to 24 variables were used for adjustments. After multivariate analysis, patients prescribed phosphate-binding agents showed a 29 and 22% lower all-cause and cardiovascular mortality risk, respectively. The survival advantage of phosphate-binding agent prescription remained statistically significant after propensity score matching analysis. A decrease of 8% in the relative risk of mortality was found for every 10% increase in the case-mix-adjusted facility prescription of phosphate-binding agents. All single and combined therapies with phosphate-binding agents, except aluminum salts, showed a beneficial association with survival. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of phosphate-binding agents on mortality.
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CITATIONS (134)
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