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Mortality in kidney disease patients treated with phosphate binders: a randomized study.
Clin J Am Soc Nephrol. 2012 Mar; 7(3):487-93.CJ

Abstract

BACKGROUND AND OBJECTIVES

Dietary phosphorous overload and excessive calcium intake from calcium-containing phosphate binders promote coronary artery calcification (CAC) that may contribute to high mortality of dialysis patients. CAC has been found in patients in early stages of nondialysis-dependent CKD. In this population, no study has evaluated the potential role of phosphorus binders on mortality. This study aimed to evaluate all-cause mortality as the primary end point in nondialysis-dependent CKD patients randomized to different phosphate binders; secondary end points were dialysis inception and the composite end point of all-cause mortality and dialysis inception.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This is a randomized, multicenter, nonblinded pilot study. Consecutive outpatients (n=212; stage 3-4 CKD) were randomized to either sevelamer (n=107) or calcium carbonate (n=105). Phosphorus concentration was maintained between 2.7 and 4.6 mg/dl for patients with stage 3-4 CKD and between 3.5 and 5.5 mg/dl for patients with stage 5 CKD. The CAC score was assessed by computed tomography at study entry and after 6, 12, 18, and 24 months. All-cause mortality, dialysis inception, and the composite end point were recorded for up to 36 months.

RESULTS

In patients randomized to sevelamer, all-cause mortality and the composite end point were lower; a nonsignificant trend was noted for dialysis inception.

CONCLUSIONS

Sevelamer provided benefits in all-cause mortality and in the composite end point of death or dialysis inception but not advantages in dialysis inception. Larger studies are needed to confirm these results.

Authors+Show Affiliations

Department of Nephrology, Ospedale A. Landolfi di Solofra, Avellino, Italy. diiorio@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22241819

Citation

Di Iorio, Biagio, et al. "Mortality in Kidney Disease Patients Treated With Phosphate Binders: a Randomized Study." Clinical Journal of the American Society of Nephrology : CJASN, vol. 7, no. 3, 2012, pp. 487-93.
Di Iorio B, Bellasi A, Russo D, et al. Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol. 2012;7(3):487-93.
Di Iorio, B., Bellasi, A., & Russo, D. (2012). Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clinical Journal of the American Society of Nephrology : CJASN, 7(3), 487-93. https://doi.org/10.2215/CJN.03820411
Di Iorio B, et al. Mortality in Kidney Disease Patients Treated With Phosphate Binders: a Randomized Study. Clin J Am Soc Nephrol. 2012;7(3):487-93. PubMed PMID: 22241819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality in kidney disease patients treated with phosphate binders: a randomized study. AU - Di Iorio,Biagio, AU - Bellasi,Antonio, AU - Russo,Domenico, AU - ,, Y1 - 2012/01/12/ PY - 2012/1/14/entrez PY - 2012/1/14/pubmed PY - 2012/7/4/medline SP - 487 EP - 93 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 7 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Dietary phosphorous overload and excessive calcium intake from calcium-containing phosphate binders promote coronary artery calcification (CAC) that may contribute to high mortality of dialysis patients. CAC has been found in patients in early stages of nondialysis-dependent CKD. In this population, no study has evaluated the potential role of phosphorus binders on mortality. This study aimed to evaluate all-cause mortality as the primary end point in nondialysis-dependent CKD patients randomized to different phosphate binders; secondary end points were dialysis inception and the composite end point of all-cause mortality and dialysis inception. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a randomized, multicenter, nonblinded pilot study. Consecutive outpatients (n=212; stage 3-4 CKD) were randomized to either sevelamer (n=107) or calcium carbonate (n=105). Phosphorus concentration was maintained between 2.7 and 4.6 mg/dl for patients with stage 3-4 CKD and between 3.5 and 5.5 mg/dl for patients with stage 5 CKD. The CAC score was assessed by computed tomography at study entry and after 6, 12, 18, and 24 months. All-cause mortality, dialysis inception, and the composite end point were recorded for up to 36 months. RESULTS: In patients randomized to sevelamer, all-cause mortality and the composite end point were lower; a nonsignificant trend was noted for dialysis inception. CONCLUSIONS: Sevelamer provided benefits in all-cause mortality and in the composite end point of death or dialysis inception but not advantages in dialysis inception. Larger studies are needed to confirm these results. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/22241819/Mortality_in_kidney_disease_patients_treated_with_phosphate_binders:_a_randomized_study_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=22241819 DB - PRIME DP - Unbound Medicine ER -