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Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders.
Clin J Am Soc Nephrol. 2017 Sep 07; 12(9):1489-1497.CJ

Abstract

BACKGROUND AND OBJECTIVES

Prior studies have shown that sevelamer attenuates progression of arterial calcification and may reduce the risk of death compared with calcium-based phosphate binders. In clinical practice, however, sevelamer is used not only as an alternative but also as an add-on therapy in patients already being treated with calcium-based phosphate binders. We analyzed the Dialysis Outcomes and Practice Patterns Study (DOPPS) data to test the hypothesis that the initiation of sevelamer is associated with improved survival in patients on hemodialysis treated with calcium-based phosphate binders.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We included 12,564 patients from DOPPS phase 3 and phase 4 (2005-2011) who were prescribed calcium-based phosphate binders at baseline or before sevelamer treatment. Mortality risk was assessed using a sequential stratification method to identify as-yet-untreated patients who were appropriately matched to the newly treated patients on the basis of their risk of death.

RESULTS

Of 12,564 patients, 2606 were subsequently treated with sevelamer hydrochloride or sevelamer carbonate. After beginning sevelamer therapy, mean serum phosphorus levels decreased by 0.3 mg/dl in the first 4 months and gradually decreased thereafter. We matched 2501 treated patients with at least one as-yet-untreated patient. Patients treated with sevelamer had a 14% lower risk for mortality compared with as-yet-untreated patients (hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97). Similar results were observed in the sensitivity analyses when changing the matching calipers or the treated and as-yet-untreated ratios, and by using propensity score matching.

CONCLUSIONS

The use of sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival in patients on maintenance hemodialysis.

Authors+Show Affiliations

Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan; hkomaba@tokai-u.jp. The Institute of Medical Sciences, Tokai University, Isehara, Japan.Arbor Research Collaborative for Health, Ann Arbor, Michigan.Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.Medical Affairs, Kyowa Hakko Kirin Co. Ltd., Tokyo, Japan.Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; and.Arbor Research Collaborative for Health, Ann Arbor, Michigan.Arbor Research Collaborative for Health, Ann Arbor, Michigan.Arbor Research Collaborative for Health, Ann Arbor, Michigan.Arbor Research Collaborative for Health, Ann Arbor, Michigan.Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.Arbor Research Collaborative for Health, Ann Arbor, Michigan. Vanderbilt University Medical Center, Nashville, Tennessee.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28724618

Citation

Komaba, Hirotaka, et al. "Initiation of Sevelamer and Mortality Among Hemodialysis Patients Treated With Calcium-Based Phosphate Binders." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 9, 2017, pp. 1489-1497.
Komaba H, Wang M, Taniguchi M, et al. Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders. Clin J Am Soc Nephrol. 2017;12(9):1489-1497.
Komaba, H., Wang, M., Taniguchi, M., Yamamoto, S., Nomura, T., Schaubel, D. E., Smith, A. R., Zee, J., Karaboyas, A., Bieber, B., Fukagawa, M., & Tentori, F. (2017). Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders. Clinical Journal of the American Society of Nephrology : CJASN, 12(9), 1489-1497. https://doi.org/10.2215/CJN.13091216
Komaba H, et al. Initiation of Sevelamer and Mortality Among Hemodialysis Patients Treated With Calcium-Based Phosphate Binders. Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1489-1497. PubMed PMID: 28724618.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders. AU - Komaba,Hirotaka, AU - Wang,Mia, AU - Taniguchi,Masatomo, AU - Yamamoto,Suguru, AU - Nomura,Takanobu, AU - Schaubel,Douglas E, AU - Smith,Abigail R, AU - Zee,Jarcy, AU - Karaboyas,Angelo, AU - Bieber,Brian, AU - Fukagawa,Masafumi, AU - Tentori,Francesca, Y1 - 2017/07/19/ PY - 2016/12/22/received PY - 2017/05/30/accepted PY - 2017/7/21/pubmed PY - 2018/5/22/medline PY - 2017/7/21/entrez KW - Calcium Phosphates KW - Calcium, Dietary KW - Confidence Intervals KW - Dialysis Outcomes and Practice Patterns Study (DOPPS): hemodialysis KW - Fluid Therapy KW - Humans KW - Phosphorus KW - Propensity Score KW - Sevelamer KW - calcium phosphate KW - hyperphosphatemia KW - renal dialysis KW - sevelamer KW - survival SP - 1489 EP - 1497 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 9 N2 - BACKGROUND AND OBJECTIVES: Prior studies have shown that sevelamer attenuates progression of arterial calcification and may reduce the risk of death compared with calcium-based phosphate binders. In clinical practice, however, sevelamer is used not only as an alternative but also as an add-on therapy in patients already being treated with calcium-based phosphate binders. We analyzed the Dialysis Outcomes and Practice Patterns Study (DOPPS) data to test the hypothesis that the initiation of sevelamer is associated with improved survival in patients on hemodialysis treated with calcium-based phosphate binders. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We included 12,564 patients from DOPPS phase 3 and phase 4 (2005-2011) who were prescribed calcium-based phosphate binders at baseline or before sevelamer treatment. Mortality risk was assessed using a sequential stratification method to identify as-yet-untreated patients who were appropriately matched to the newly treated patients on the basis of their risk of death. RESULTS: Of 12,564 patients, 2606 were subsequently treated with sevelamer hydrochloride or sevelamer carbonate. After beginning sevelamer therapy, mean serum phosphorus levels decreased by 0.3 mg/dl in the first 4 months and gradually decreased thereafter. We matched 2501 treated patients with at least one as-yet-untreated patient. Patients treated with sevelamer had a 14% lower risk for mortality compared with as-yet-untreated patients (hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97). Similar results were observed in the sensitivity analyses when changing the matching calipers or the treated and as-yet-untreated ratios, and by using propensity score matching. CONCLUSIONS: The use of sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival in patients on maintenance hemodialysis. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28724618/Initiation_of_Sevelamer_and_Mortality_among_Hemodialysis_Patients_Treated_with_Calcium_Based_Phosphate_Binders_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=28724618 DB - PRIME DP - Unbound Medicine ER -