Use of phosphate-binding agents is associated with a lower risk of mortality

• DOI: 10.1038/ki.2013.185
• Publication Date: 2013-07-03T12:39:09Z
• Authors: Jorge B. Cannata-...; José L. Fernández...; Francesco Locatelli; Gérard London; José L. Gorriz; Jürgen Floege; Markus Ketteler; Aníbal Ferreira; Adrian Covic; Boleslaw Rutkowski; Dimitrios Memmos; Willem-Jan Bos; Vladimir Teplan; Judit Nagy; Christian Tielemans; Dierik Verbeelen; David Goldsmith; Reinhard Kramar; Pierre-Yves Martin; Rudolf P. Wüthrich; Drasko Pavlovic; Miha Benedik; José Emilio Sánchez; Pablo Martínez-Ca...; Manuel Naves-Díaz; Juan J. Carrero; Carmine Zoccali
• Keywords: 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

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.