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

Cannata-Andía, Jorge B
Fernández-Martín, José L
Locatelli, Francesco
London, Gérard
Gorriz, José L
Floege, Jürgen
Ketteler, Markus
Ferreira, Aníbal
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Published in Kidney International. 2013, vol. 84, no. 5, p. 998-1008
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.
Keywords AgedAged, 80 and overBiological Markers/bloodCardiovascular Diseases/diagnosis/mortality/prevention & controlChelating Agents/therapeutic useChi-Square DistributionEurope/epidemiologyFemaleHumansHyperphosphatemia/blood/diagnosis/drug therapy/mortalityMaleMiddle AgedMultivariate AnalysisPhosphates/bloodPropensity ScoreProportional Hazards ModelsProspective StudiesRenal Dialysis/adverse effects/mortalityRenal Insufficiency, Chronic/blood/diagnosis/mortality/therapyRisk FactorsTime FactorsTreatment Outcome
PMID: 23823605
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Research group Groupe Pierre-Yves Martin (néphrologie) (30)
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CANNATA-ANDÍA, Jorge B et al. Use of phosphate-binding agents is associated with a lower risk of mortality. In: Kidney International, 2013, vol. 84, n° 5, p. 998-1008. doi: 10.1038/ki.2013.185 https://archive-ouverte.unige.ch/unige:43598

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Deposited on : 2014-12-17

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