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). STUDY DESIGN: Historical cohort. SETTING & PARTICIPANTS: 1,188 men with moderate and advanced non-dialysis-dependent CKD at a single medical center. PREDICTOR: Administration of any phosphorus binder. OUTCOMES & MEASUREMENTS: 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. LIMITATIONS: 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. Published by Elsevier Inc.
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). STUDY DESIGN: Historical cohort. SETTING & PARTICIPANTS: 1,188 men with moderate and advanced non-dialysis-dependent CKD at a single medical center. PREDICTOR: Administration of any phosphorus binder. OUTCOMES & MEASUREMENTS: 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. LIMITATIONS: 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. Published by Elsevier Inc.
Authors: Bryan Kestenbaum; Joshua N Sampson; Kyle D Rudser; Donald J Patterson; Stephen L Seliger; Bessie Young; Donald J Sherrard; Dennis L Andress Journal: J Am Soc Nephrol Date: 2004-12-22 Impact factor: 10.121
Authors: G Maschio; L Oldrizzi; N Tessitore; A D'Angelo; E Valvo; A Lupo; C Loschiavo; A Fabris; L Gammaro; C Rugiu; G Panzetta Journal: Kidney Int Date: 1982-10 Impact factor: 10.612
Authors: Geoffrey A Block; Preston S Klassen; J Michael Lazarus; Norma Ofsthun; Edmund G Lowrie; Glenn M Chertow Journal: J Am Soc Nephrol Date: 2004-08 Impact factor: 10.121
Authors: Marcelo S Sampaio; Miklos Z Molnar; Csaba P Kovesdy; Rajnish Mehrotra; Istvan Mucsi; John J Sim; Mahesh Krishnan; Allen R Nissenson; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2011-09-29 Impact factor: 8.237
Authors: Antonio Alberto Lopes; Lin Tong; Jyothi Thumma; Yun Li; Douglas S Fuller; Hal Morgenstern; Jürgen Bommer; Peter G Kerr; Francesca Tentori; Takashi Akiba; Brenda W Gillespie; Bruce M Robinson; Friedrich K Port; Ronald L Pisoni Journal: Am J Kidney Dis Date: 2012-03-03 Impact factor: 8.860
Authors: Geoffrey A Block; David C Wheeler; Martha S Persky; Bryan Kestenbaum; Markus Ketteler; David M Spiegel; Matthew A Allison; John Asplin; Gerard Smits; Andrew N Hoofnagle; Laura Kooienga; Ravi Thadhani; Michael Mannstadt; Myles Wolf; Glenn M Chertow Journal: J Am Soc Nephrol Date: 2012-07-19 Impact factor: 10.121
Authors: Kamyar Kalantar-Zadeh; Noël J Cano; Klemens Budde; Charles Chazot; Csaba P Kovesdy; Robert H Mak; Rajnish Mehrotra; Dominic S Raj; Ashwini R Sehgal; Peter Stenvinkel; T Alp Ikizler Journal: Nat Rev Nephrol Date: 2011-05-31 Impact factor: 28.314
Authors: Tamara Isakova; Joachim H Ix; Stuart M Sprague; Kalani L Raphael; Linda Fried; Jennifer J Gassman; Dominic Raj; Alfred K Cheung; John W Kusek; Michael F Flessner; Myles Wolf; Geoffrey A Block Journal: J Am Soc Nephrol Date: 2015-05-12 Impact factor: 10.121