Outcomes associated with phosphorus binders in men with non-dialysis-dependent CKD

Csaba Kovesdy, Olga Kuchmak, Jun Ling Lu, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

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 nondialysis-dependent chronic kidney disease (CKD). Study Design Historical cohort. Setting & Participants 1,188 men with moderate and advanced nondialysis-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 nondialysis-dependent CKD. Conclusions Administration of phosphorus binders is associated with lower mortality in men with moderate and advanced nondialysis-dependent CKD. Clinical trials are needed to determine the risks and benefits of phosphorus-binder use in this patient population.

Original languageEnglish (US)
Pages (from-to)842-851
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume56
Issue number5
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Chronic Renal Insufficiency
Phosphorus
Mortality
Intention to Treat Analysis
Hyperphosphatemia
Propensity Score
Glomerular Filtration Rate
Proportional Hazards Models
Observational Studies
Dialysis
Cohort Studies
Maintenance
Clinical Trials
Kidney
Population

All Science Journal Classification (ASJC) codes

  • Nephrology

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Outcomes associated with phosphorus binders in men with non-dialysis-dependent CKD. / Kovesdy, Csaba; Kuchmak, Olga; Lu, Jun Ling; Kalantar-Zadeh, Kamyar.

In: American Journal of Kidney Diseases, Vol. 56, No. 5, 01.11.2010, p. 842-851.

Research output: Contribution to journalArticle

Kovesdy, Csaba ; Kuchmak, Olga ; Lu, Jun Ling ; Kalantar-Zadeh, Kamyar. / Outcomes associated with phosphorus binders in men with non-dialysis-dependent CKD. In: American Journal of Kidney Diseases. 2010 ; Vol. 56, No. 5. pp. 842-851.
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abstract = "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 nondialysis-dependent chronic kidney disease (CKD). Study Design Historical cohort. Setting & Participants 1,188 men with moderate and advanced nondialysis-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 nondialysis-dependent CKD. Conclusions Administration of phosphorus binders is associated with lower mortality in men with moderate and advanced nondialysis-dependent CKD. Clinical trials are needed to determine the risks and benefits of phosphorus-binder use in this patient population.",
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N2 - 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 nondialysis-dependent chronic kidney disease (CKD). Study Design Historical cohort. Setting & Participants 1,188 men with moderate and advanced nondialysis-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 nondialysis-dependent CKD. Conclusions Administration of phosphorus binders is associated with lower mortality in men with moderate and advanced nondialysis-dependent CKD. Clinical trials are needed to determine the risks and benefits of phosphorus-binder use in this patient population.

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