Use of phosphate-binding agents is associated with a lower risk of mortality.
Title | Use of phosphate-binding agents is associated with a lower risk of mortality. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Cannata-Andia, J. B., Fernández-Martín J. L., Locatelli F., London G., Gorriz J. L., Floege J., Ketteler M., Ferreira A., Covic A., Rutkowski B., Memmos D., Bos W-J., Teplan V., Nagy J., Tielemans C., Verbeelen D., Goldsmith D., Kramar R., Martin P-Y., Wüthrich R. P., Pavlovic D., Benedik M., Sánchez J. Emilio, Martínez-Camblor P., Naves-Díaz M., Carrero J. J., & Zoccali C. |
Journal | Kidney Int |
Volume | 84 |
Issue | 5 |
Pagination | 998-1008 |
Date Published | 2013 Nov |
ISSN | 1523-1755 |
Keywords | Aged, Aged, 80 and over, Biological Markers, Cardiovascular Diseases, Chelating Agents, Chi-Square Distribution, Europe, Female, Humans, Hyperphosphatemia, Male, Middle Aged, Multivariate Analysis, Phosphates, Propensity Score, Proportional Hazards Models, Prospective Studies, Renal Dialysis, Renal Insufficiency, Chronic, Risk Factors, Time Factors, Treatment Outcome |
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. |
DOI | 10.1038/ki.2013.185 |
Alternate Journal | Kidney Int. |
PubMed ID | 23823605 |