Outcomes associated with phosphorus binders in men with non-dialysis-dependent CKD.
BACKGROUND
Phosphorus binders are used to treat hyperphosphatemia in maintenance dialysis patients, in whom the use of these medications has been associated with lower mortality in some observational studies. It is not clear whether similar benefits can be seen in patients with non-dialysis-dependent chronic kidney disease (CKD).


METHODS
Historical cohort.


METHODS
1,188 men with moderate and advanced non-dialysis-dependent CKD at a single medical center.


METHODS
Administration of any phosphorus binder.


METHODS
We examined associations of any phosphorus-binder administration with all-cause mortality and the slopes of estimated glomerular filtration rate using time-varying Cox models and mixed-effects models. Associations also were examined in intention-to-treat analyses and in 133 patient-pairs matched according to propensity scores.


RESULTS
344 patients were treated with a phosphorus binder; 658 patients died (mortality rate, 141 deaths/1,000 patient-years; 95% CI, 131-153) during a median follow-up of 3.1 years. Treatment with phosphorus binders was associated with significantly lower mortality (adjusted HR, 0.61; 95% CI, 0.45-0.81; P < 0.001). Results were similar when exposure was modeled in intention-to-treat analyses and examining propensity-matched patients. Phosphorus-binder use was not associated with significant changes in kidney function loss.


CONCLUSIONS
Results may not apply to all patients with non-dialysis-dependent CKD.


CONCLUSIONS
Administration of phosphorus binders is associated with lower mortality in men with moderate and advanced non-dialysis-dependent CKD. Clinical trials are needed to determine the risks and benefits of phosphorus-binder use in this patient population.
Kovesdy
Csaba P
CP
Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, VA 24153, USA. csaba.kovesdy@va.gov
Kuchmak
Olga
O
Lu
Jun Ling
JL
Kalantar-Zadeh
Kamyar
K
D000368:Aged; D050071:Bone Density Conservation Agents / Q000493:pharmacokinetics*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D056687:Off-Label Use; D010710:Phosphates / Q000378:metabolism*; D010758:Phosphorus / Q000097:blood*; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D010710:Phosphates; D010758:Phosphorus