Outcomes Associated With Phosphorus Binders in Men With Non-Dialysis-Dependent CKD

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. Am J Kidney Dis 56: 842-851. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use.