Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients.
The risk of death in hemodialysis patients treated with calcium-containing phosphate binders or sevelamer is not known. We assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization. This was a predetermined secondary end point of a randomized clinical trial designed to assess progression of coronary artery calcium (CAC) scores in the two treatment arms. Thirty-four deaths occurred during the follow-up period: 23 in subjects randomized to calcium-containing phosphate binders and 11 in subjects randomized to sevelamer. Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score (P=0.002). Mortality was borderline significantly lower in subjects randomized to sevelamer (5.3/100 patient years, confidence interval (CI) (2.2-8.5) compared to those randomized to calcium-containing binders (10.6/100 patient years, CI 6.3-14.9) (P=0.05). The greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment (P=0.016, hazard ratio 3.1, CI 1.23-7.61). In subjects new to hemodialysis baseline CAC score was a significant predictor of all-cause mortality. Treatment with sevelamer was associated with a significant survival benefit as compared to the use of calcium-containing phosphate binders.
Block
G A
GA
Clinical Research Division, Denver Nephrology, Denver, CO 80230, USA. gablock@denverneph.net
Raggi
P
P
Bellasi
A
A
Kooienga
L
L
Spiegel
D M
DM
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000209:etiology / Q000517:prevention & control*; D002130:Calcium Phosphates / Q000097:blood; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D000069603:Sevelamer
D002130:Calcium Phosphates; D011073:Polyamines; C020243:calcium phosphate; D000069603:Sevelamer