title: Phosphorus binders and survival on hemodialysis.
abstract: Although hyperphosphatemia is a risk factor for mortality, there are limited data on whether therapy with phosphorus binders affects survival. We analyzed a prospective cohort study of 10,044 incident hemodialysis patients using Cox proportional hazards analyses to compare 1-yr all-cause mortality among patients who were or were not treated with phosphorus binders. We performed intention-to-treat analyses to compare patients who began treatment with phosphorus binders during the first 90 d after initiating hemodialysis (n = 3555) with those who remained untreated during that period (n = 5055). We also performed as-treated analyses that modeled phosphorus binder treatment as a time-dependent exposure. We compared survival in a subcohort of treated (n = 3186) and untreated (n = 3186) patients matched by their baseline serum phosphate levels and propensity score of receiving phosphorus binders during the first 90 d. One-year mortality was 191 deaths/1000 patient-years at risk. Treatment with phosphorus binders was independently associated with decreased mortality compared with no treatment in the intention-to-treat, as-treated, and matched analyses. The results were independent of baseline and follow-up serum phosphate levels and persisted in analyses that excluded deaths during the first 90 d of hemodialysis. In summary, treatment with phosphorus binders is independently associated with improved survival among incident hemodialysis patients. Although confirmatory studies are needed in the dialysis setting, future placebo-controlled, randomized trials of phosphorus binders might focus on predialysis patients with chronic kidney disease and normal serum phosphate levels.
authors.affiliation: Renal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.forename: Hector
authors.initials: H
authors.lastname: Tamez
authors.forename: Kelsey
authors.initials: K
authors.lastname: Smith
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood / Q000737:chemistry* / Q000627:therapeutic use; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010758:Phosphorus