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Abstract: ASN Annual Meeting -- San Diego |
Kuchmak O, Kalantar-Zadeh K, Kovesdy CP.
Phosphate Binder Use and Outcomes in Non-Dialysis Dependent Chronic Kidney Disease.
ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:366A 2009
The use of phosphate binders has been associated with better outcomes in dialysis patients. Similar studies have not been performed in patients with non-dialysis dependent CKD (NDD-CKD). We examined the association of calcium and sevelamer hydrochloride use with all-cause mortality and the slopes of eGFR in 1,188 male US veterans with NDD-CKD stage 1-5.
Associations were examined in time-dependent Cox models for mortality and in mixed effects models for slopes, with adjustment for age, race, comorbidities, blood pressure, BMI, smoking, vitamin D use, eGFR, alkaline phosphatase, calcium, phosphorus, albumin, bicarbonate, hemoglobin, WBC count, percentage of lymphocytes in WBC count and proteinuria. 344 patients (32%) were administered some form of phosphate binder; of these, 234 (20%) were on calcium alone, 31 (3%) were on sevelamer alone and 79 (7%) were on both calcium and sevelamer. Compared to patients on no binders the use of any binder was associated with significantly lower mortality and with a beneficial change in the slopes of eGFR (Table). Results were similar in those exclusively on calcium binders or on sevelamer.
Any binder N=344 Mortality (HR, 95%CI) Unadjusted 1.15 (0.95, 1.41) Fully adjusted 0.68 (0.54. 0.85) Slope of eGFR (ml/min/1.73m2/year) Unadjusted 0.08 (-0.03, 0.19) Fully adjusted 0.17 (0.06, 0.29)
The adjusted association of calcium-type binders with mortality did not vary according to the daily amount of elemental calcium intake (Figure).
Phosphate binder use is associated with lower mortality and with decreased loss of kidney function in NDD-CKD. Interventional trials are needed to determine if the use of binders can result in improved outcomes in this population.
© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
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