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CLINICAL EPIDEMIOLOGY
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Phosphorus Binders and Survival on Hemodialysis

Tamara Isakova, Orlando M. Gutiérrez, Yuchiao Chang, Anand Shah, Hector Tamez, Kelsey Smith, Ravi Thadhani and Myles Wolf
JASN February 2009, 20 (2) 388-396; DOI: https://doi.org/10.1681/ASN.2008060609
Tamara Isakova
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Orlando M. Gutiérrez
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Yuchiao Chang
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Anand Shah
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Hector Tamez
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Kelsey Smith
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Ravi Thadhani
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Myles Wolf
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Abstract

Although hyperphosphatemia is a risk factor for mortality, there are limited data on whether therapy with phosphorus binders affects survival. We analyzed a prospective cohort study of 10,044 incident hemodialysis patients using Cox proportional hazards analyses to compare 1-yr all-cause mortality among patients who were or were not treated with phosphorus binders. We performed intention-to-treat analyses to compare patients who began treatment with phosphorus binders during the first 90 d after initiating hemodialysis (n = 3555) with those who remained untreated during that period (n = 5055). We also performed as-treated analyses that modeled phosphorus binder treatment as a time-dependent exposure. We compared survival in a subcohort of treated (n = 3186) and untreated (n = 3186) patients matched by their baseline serum phosphate levels and propensity score of receiving phosphorus binders during the first 90 d. One-year mortality was 191 deaths/1000 patient-years at risk. Treatment with phosphorus binders was independently associated with decreased mortality compared with no treatment in the intention-to-treat, as-treated, and matched analyses. The results were independent of baseline and follow-up serum phosphate levels and persisted in analyses that excluded deaths during the first 90 d of hemodialysis. In summary, treatment with phosphorus binders is independently associated with improved survival among incident hemodialysis patients. Although confirmatory studies are needed in the dialysis setting, future placebo-controlled, randomized trials of phosphorus binders might focus on predialysis patients with chronic kidney disease and normal serum phosphate levels.

  • Copyright © 2009 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 20 (2)
Journal of the American Society of Nephrology
Vol. 20, Issue 2
February 2009
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Phosphorus Binders and Survival on Hemodialysis
Tamara Isakova, Orlando M. Gutiérrez, Yuchiao Chang, Anand Shah, Hector Tamez, Kelsey Smith, Ravi Thadhani, Myles Wolf
JASN Feb 2009, 20 (2) 388-396; DOI: 10.1681/ASN.2008060609

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Phosphorus Binders and Survival on Hemodialysis
Tamara Isakova, Orlando M. Gutiérrez, Yuchiao Chang, Anand Shah, Hector Tamez, Kelsey Smith, Ravi Thadhani, Myles Wolf
JASN Feb 2009, 20 (2) 388-396; DOI: 10.1681/ASN.2008060609
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  • Can we IMPROVE cardiovascular outcomes through phosphate lowering in CKD? Rationale and protocol for the IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease (IMPROVE-CKD) study
  • Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders
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  • Association of Parameters of Mineral Bone Disorder with Mortality in Patients on Hemodialysis according to Level of Residual Kidney Function
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  • FGF23: Is It Ready for Prime Time?
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  • Glycated Albumin and Risk of Death and Hospitalizations in Diabetic Dialysis Patients
  • Clinical Efficacy and Cost-Effectiveness of Lanthanum Carbonate as Second-Line Therapy in Hemodialysis Patients in Japan
  • Elevated Fibroblast Growth Factor 23 is a Risk Factor for Kidney Transplant Loss and Mortality
  • Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients
  • Prevention and Control of Phosphate Retention/Hyperphosphatemia in CKD-MBD: What Is Normal, When to Start, and How to Treat?
  • Comparative Effectiveness of Calcium-Containing Phosphate Binders in Incident U.S. Dialysis Patients
  • Klotho Deficiency Causes Vascular Calcification in Chronic Kidney Disease
  • Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients
  • Conjoint Effects of Serum Calcium and Phosphate on Risk of Total, Cardiovascular, and Noncardiovascular Mortality in the Community
  • Ten-Year Experience with Sevelamer and Calcium Salts as Phosphate Binders
  • Vascular Calcification and ESRD: A Hard Target
  • Economic Evaluation of Sevelamer versus Calcium-Based Phosphate Binders in Hemodialysis Patients: A Secondary Analysis using Centers for Medicare & Medicaid Services Data
  • Secondary Hyperparathyroidism: Pathophysiology and Treatment
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