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
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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