Use of phosphate-binding agents is associated with a lower risk of mortality

Jorge B. Cannata-Andía, José L. Fernández-Martín, Francesco Locatelli, Gérard London, José L. Gorriz, Jürgen Floege, Markus Ketteler, Aníbal Ferreira, Adrian Covic, Boleslaw Rutkowski, Dimitrios Memmos, Willem Jan Bos, Vladimir Teplan, J. Nagy, Christian Tielemans, Dierik Verbeelen, David Goldsmith, Reinhard Kramar, Pierre Yves Martin, Rudolf P. WüthrichDrasko Pavlovic, Miha Benedik, José Emilio Sánchez, Pablo Martínez-Camblor, Manuel Naves-Díaz, Juan J. Carrero, Carmine Zoccali

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)998-1008
Number of pages11
JournalKidney International
Volume84
Issue number5
DOIs
Publication statusPublished - Nov 2013

Fingerprint

Phosphates
Mortality
Prescriptions
Diagnosis-Related Groups
Survival
Dialysis
Hyperphosphatemia
Propensity Score
Aluminum
Proportional Hazards Models
Observational Studies
Multivariate Analysis
Randomized Controlled Trials
Salts
Prospective Studies

Keywords

  • dialysis
  • hyperparathyroidism
  • hyperphosphatemia
  • mineral metabolism
  • mortality risk
  • phosphate binders

ASJC Scopus subject areas

  • Nephrology

Cite this

Cannata-Andía, J. B., Fernández-Martín, J. L., Locatelli, F., London, G., Gorriz, J. L., Floege, J., ... Zoccali, C. (2013). Use of phosphate-binding agents is associated with a lower risk of mortality. Kidney International, 84(5), 998-1008. https://doi.org/10.1038/ki.2013.185

Use of phosphate-binding agents is associated with a lower risk of mortality. / Cannata-Andía, Jorge B.; Fernández-Martín, José L.; Locatelli, Francesco; London, Gérard; Gorriz, José L.; Floege, Jürgen; Ketteler, Markus; Ferreira, Aníbal; Covic, Adrian; Rutkowski, Boleslaw; Memmos, Dimitrios; Bos, Willem Jan; Teplan, Vladimir; Nagy, J.; Tielemans, Christian; Verbeelen, Dierik; Goldsmith, David; Kramar, Reinhard; Martin, Pierre Yves; Wüthrich, Rudolf P.; Pavlovic, Drasko; Benedik, Miha; Sánchez, José Emilio; Martínez-Camblor, Pablo; Naves-Díaz, Manuel; Carrero, Juan J.; Zoccali, Carmine.

In: Kidney International, Vol. 84, No. 5, 11.2013, p. 998-1008.

Research output: Contribution to journalArticle

Cannata-Andía, JB, Fernández-Martín, JL, Locatelli, F, London, G, Gorriz, JL, Floege, J, Ketteler, M, Ferreira, A, Covic, A, Rutkowski, B, Memmos, D, Bos, WJ, Teplan, V, Nagy, J, Tielemans, C, Verbeelen, D, Goldsmith, D, Kramar, R, Martin, PY, Wüthrich, RP, Pavlovic, D, Benedik, M, Sánchez, JE, Martínez-Camblor, P, Naves-Díaz, M, Carrero, JJ & Zoccali, C 2013, 'Use of phosphate-binding agents is associated with a lower risk of mortality', Kidney International, vol. 84, no. 5, pp. 998-1008. https://doi.org/10.1038/ki.2013.185
Cannata-Andía JB, Fernández-Martín JL, Locatelli F, London G, Gorriz JL, Floege J et al. Use of phosphate-binding agents is associated with a lower risk of mortality. Kidney International. 2013 Nov;84(5):998-1008. https://doi.org/10.1038/ki.2013.185
Cannata-Andía, Jorge B. ; Fernández-Martín, José L. ; Locatelli, Francesco ; London, Gérard ; Gorriz, José L. ; Floege, Jürgen ; Ketteler, Markus ; Ferreira, Aníbal ; Covic, Adrian ; Rutkowski, Boleslaw ; Memmos, Dimitrios ; Bos, Willem Jan ; Teplan, Vladimir ; Nagy, J. ; Tielemans, Christian ; Verbeelen, Dierik ; Goldsmith, David ; Kramar, Reinhard ; Martin, Pierre Yves ; Wüthrich, Rudolf P. ; Pavlovic, Drasko ; Benedik, Miha ; Sánchez, José Emilio ; Martínez-Camblor, Pablo ; Naves-Díaz, Manuel ; Carrero, Juan J. ; Zoccali, Carmine. / Use of phosphate-binding agents is associated with a lower risk of mortality. In: Kidney International. 2013 ; Vol. 84, No. 5. pp. 998-1008.
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