Phosphate Binders and Clinical Outcomes in Patients with Stage 5D Chronic Kidney Disease.
Knowledge informing the prescription and the choice of phosphate binders in end stage kidney disease (ESKD) patients has a weak evidentiary base. To date, no placebo-controlled trial based on meaningful clinical endpoints (death, cardiovascular events, bone fractures) has been performed to test the efficacy of these drugs. By the same token, we still lack solid proof that noncalcium binders afford better clinical outcomes as compared with calcium-based binders. Without proper trials, clinical decisions about the treatment of hyperphosphatemia rest on experience and contingent clinical judgment. The use of huge doses of calcium-based binders typically prescribed in the nineties now appears unwarranted. The relationship between phosphate and the risk of death is U shaped and moderate hyperphosphatemia carries just a mild-to-moderate risk excess and may not be seen as a compelling indication for the prescription of phosphate binders. Placebo-controlled randomized clinical trials assessing whether non-calcium and calcium-based binders reduce the risk of death and cardiovascular disease events in ESKD patients remain a public health priority.
CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal c/o Ospedali Riuniti, Reggio Cal, Italy.
Carmine
C
Zoccali
CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal c/o Ospedali Riuniti, Reggio Cal, Italy.|Nephrology, Transplantation and Hypertension Division, Ospedali Riuniti, Reggio Cal, Italy.
Francesca
F
Mallamaci
Bone and Mineral Research Unit, Reina Sofia Research Institute of the Hospital, Universitario Central de Asturias.|Department of Medicine, University of Oviedo, Oviedo, Spain.
Jorge
J
Cannata-Andía
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D014943:Global Health; D006801:Humans; D054559:Hyperphosphatemia / Q000150:complications / Q000378:metabolism / Q000517:prevention & control; D009017:Morbidity / Q000639:trends; D010710:Phosphates / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D012720:Severity of Illness Index
D010710:Phosphates