期刊
KIDNEY INTERNATIONAL
卷 84, 期 5, 页码 998-1008出版社
ELSEVIER SCIENCE INC
DOI: 10.1038/ki.2013.185
关键词
dialysis; hyperparathyroidism; hyperphosphatemia; mineral metabolism; mortality risk; phosphate binders
资金
- Bone and Mineral Research Unit (Hospital Universitario Central de Asturias)
- SAFIM (Sociedad Asturiana Fomento Investigaciones Oseas)
- European Renal Association-European Dialysis and Transplant Association
- ISCIII-Retic-RD06
- REDinREN [16/06]
- Fundacion Renal Inigo Alvarez de Toledo (FRIAT)
- AMGEN Europe
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.
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