Use of phosphate-binding agents is associated with a lower risk of mortality

Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix–adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models.

Three different multivariate models that included up to 24 variables were used for adjustments. After multivariate analysis, patients prescribed phosphate-binding agents showed a 29 and 22% lower all-cause and cardiovascular mortality risk, respectively. The survival advantage of phosphate-binding agent prescription remained statistically significant after propensity score matching analysis. A decrease of 8% in the relative risk of mortality was found for every 10% increase in the case-mix–adjusted facility prescription of phosphate-binding agents. All single and combined therapies with phosphate-binding agents, except aluminum salts, showed a beneficial association with survival. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of phosphate-binding agents on mortality.

Use of phosphate-binding agents is associated with a lower risk of mortality FREE
Jorge B Cannata-And?a, Jos? L Fern?ndez-Mart?n, Francesco Locatelli, G?rard London, Jos? L Gorriz, J?rgen Floege, Markus Ketteler, An?bal Ferreira, Adrian Covic, Boleslaw Rutkowski, Dimitrios Memmos, Willem-Jan Bos, Vladimir Teplan, Judit Nagy, Christian Tielemans, Dierik Verbeelen, David Goldsmith, Reinhard Kramar, Pierre-Yves Martin, Rudolf P W?thrich, Drasko Pavlovic, Miha Benedik, Jos? Emilio S?nchez, Pablo Mart?nez-Camblor, Manuel Naves-D?az, Juan J Carrero and Carmine Zoccali
Kidney Int 84: 998-1008; advance online publication, July 3, 2013; doi:10.1038/ki.2013.185

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