title: Comparative effectiveness of calcium acetate and sevelamer on clinical outcomes in elderly hemodialysis patients enrolled in Medicare part D.
abstract: BACKGROUND
  Phosphate binders are an important therapeutic option for managing hyperphosphatemia in hemodialysis patients. Whether sevelamer confers a survival advantage over calcium acetate is unclear.
  
  
  METHODS
  Observational cohort study using US Renal Data System (USRDS) data linked to Medicare Part D prescription drug data.
  
  
  METHODS
  Medicare-enrolled elderly incident hemodialysis patients initiating calcium acetate or sevelamer therapy between July 1, 2006, and March 31, 2011.
  
  
  METHODS
  Prescription for sevelamer (hydrochloride or carbonate) or calcium acetate.
  
  
  METHODS
  All-cause and cardiovascular-related mortality, hospital admissions and hospital days assessed from Medicare Parts A, B, and D claims and other USRDS data.
  
  
  RESULTS
  The sevelamer and calcium-acetate groups included 16,916 and 18,335 patients, respectively. After multivariable adjustment, all-cause (21.9 vs 21.8 deaths/100 patient-years; adjusted HR, 0.97; 95% CI, 0.94-1.03) and cardiovascular (8.7 vs 8.6 deaths/100 patient-years; HR, 0.99; 95% CI, 0.93-1.04) mortality did not differ significantly between the sevelamer and calcium-acetate (referent) groups. Mortality results in propensity score-matched cohorts showed significantly lower risk of death in sevelamer- than in calcium-acetate-treated patients (HR, 0.94; 95% CI, 0.91-0.98). Mortality results from additional analyses including only patients with low-income subsidy status were consistent with results from analyses including patients with and without low-income subsidy status. There were no significant differences between the sevelamer and calcium-acetate groups for all-cause and cardiovascular-related first hospitalization, multiple hospitalizations, and hospital days.
  
  
  CONCLUSIONS
  Results may not be applicable to younger patients; information about laboratory data and over-the-counter calcium-containing binders was lacking.
  
  
  CONCLUSIONS
  Relative to treatment with calcium acetate, treatment with sevelamer was associated with similar or slightly lower risk of death and similar risk of hospitalization in elderly incident hemodialysis patients.
authors.affiliation: US Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN; University of Minnesota, College of Pharmacy, Minneapolis, MN.
authors.forename: Akeem A
authors.initials: AA
authors.lastname: Yusuf
authors.affiliation: US Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Weinhandl
authors.affiliation: US Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN; University of Minnesota, College of Pharmacy, Minneapolis, MN. Electronic address: wstpeter@usrds.org.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: St Peter
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D017610:Calcium Compounds / Q000627:therapeutic use; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D054524:Medicare Part D; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D011073:Polyamines; D000069603:Sevelamer; C120662:calcium acetate
keywords: Medicare Part D; calcium acetate; cardiovascular disease; comparative effectiveness; coronary calcification; dialysis; elderly; end-stage renal disease (ESRD); hyperphosphatemia; mortality; phosphate binders; sevelamer