title: Calcium carbonate, but not sevelamer, is associated with better outcomes in hemodialysis patients: results from the French ARNOS study.
abstract: A favorable survival effect of phosphate binders (PBs) on incident hemodialysis (HD) patients was recently reported, but no definitive advantages of calcium-based or noncalcium-based PBs have been demonstrated. The aim of this study was to assess the impact of the prescription of PBs using calcium carbonate (CaCO(3) ) or sevelamer HCl (SV) on survival. Baseline PB prescription was recorded using a cross-sectional analysis of prevalent HD patients from the regional Association Régionale des Néphrologues OStéodystrophie French cohort. A prospective 42-month survival analysis study was performed. In July 2005, 1347 HD patients were included. CaCO(3) , SV, and mixed PBs were prescribed in 55%, 42%, and 24% of cases, respectively, and 26% were not prescribed PBs. Using a Cox proportional model adjusted for several parameters, CaCO(3)  use was found to be associated with less mortality (HR, 0.64 [0.4-0.78]), but not in the case of SV use (HR, 1.13 [0.92-1.3]). SV prescription was associated with higher mortality than CaCO(3)  (HR, 1.46 [1.1-1.9]). CaCO3, but not sevelamer prescription, is associated with a favorable effect on survival in a French HD population. This novel result can be partly accounted for by the differences in mineral metabolism disorder management that exist between randomized controlled trials and "real life" conditions.
authors: Centre de Rein Artificiel, Service d'Hémodialyse, Tassin, France. guillaume-jean-crat@wanadoo.fr
authors: Guillaume
authors: G
authors: Jean
authors: Dominique
authors: D
authors: Lataillade
authors: Leslie
authors: L
authors: Genet
authors: Eric
authors: E
authors: Legrand
authors: François
authors: F
authors: Kuentz
authors: Xavier
authors: X
authors: Moreau-Gaudry
authors: Denis
authors: D
authors: Fouque
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000008:administration & dosage*; D002119:Calcium Carbonate / Q000008:administration & dosage*; D002614:Chelating Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000008:administration & dosage*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D000069603:Sevelamer; D015996:Survival Rate
chemical_list: D000863:Antacids; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer; D002119:Calcium Carbonate