Phosphorus Binders and Survival on Hemodialysis
Phosphorus Binders and Survival on Hemodialysis
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DOI：
10.1681/asn.2008060609
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发表时间：
2009-02-01
影响因子：
13.6
通讯作者：
Wolf, Myles
中科院分区：
文献类型：
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作者：
Isakova, Tamara;Gutierrez, Orlando M.;Wolf, Myles
虽然高磷血症是死亡的危险因素，但关于磷结合剂治疗是否影响生存率的数据有限。我们采用考克斯比例风险分析对10,044例血液透析患者进行了前瞻性队列研究，比较了接受或未接受磷结合剂治疗患者的1年全因死亡率。我们进行了意向性治疗分析，以比较在开始血液透析后的前90天内开始使用磷结合剂治疗的患者（n = 3555）与在此期间未接受治疗的患者（n = 5055）。我们还进行了处理分析，将磷结合剂处理建模为时间依赖性暴露。我们比较了治疗组（n = 3186）和未治疗组（n = 3186）患者的生存率，这些患者的基线血清磷水平和前90天接受磷结合剂的倾向评分相匹配。1年死亡率为191例死亡/1000风险患者年。在意向治疗、实际治疗和匹配分析中，与未治疗相比，磷结合剂治疗与死亡率降低独立相关。这些结果与基线和随访血清磷水平无关，并且在排除血液透析前90天死亡的分析中持续存在。总之，磷结合剂治疗与血液透析患者生存率的改善独立相关。虽然需要在透析环境中进行验证性研究，但未来的安慰剂对照、磷结合剂随机试验可能会集中在慢性肾脏疾病和血清磷水平正常的透析前患者。
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.