en
Scientific article
English

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

Published inKidney international, vol. 84, no. 5, p. 998-1008
Publication date2013
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
  • Aged
  • Aged, 80 and over
  • Biological Markers/blood
  • Cardiovascular Diseases/diagnosis/mortality/prevention & control
  • Chelating Agents/therapeutic use
  • Chi-Square Distribution
  • Europe/epidemiology
  • Female
  • Humans
  • Hyperphosphatemia/blood/diagnosis/drug therapy/mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Phosphates/blood
  • Propensity Score
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Dialysis/adverse effects/mortality
  • Renal Insufficiency, Chronic/blood/diagnosis/mortality/therapy
  • Risk Factors
  • Time Factors
  • Treatment Outcome
Citation (ISO format)
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
Main files (1)
Article (Published version)
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Identifiers
ISSN of the journal0085-2538
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