Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders
Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders
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DOI：
10.2215/cjn.13091216
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发表时间：
2017-09-07
影响因子：
9.8
通讯作者：
Tentori, Francesca
中科院分区：
文献类型：
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作者：
Komaba, Hirotaka;Wang, Mia;Tentori, Francesca
背景和目的既往研究表明，与钙磷结合剂相比，司维拉姆可减缓动脉钙化的进展，并可能降低死亡风险。然而，在临床实践中，司维拉姆不仅用作替代疗法，而且还用作已接受钙基磷结合剂治疗的患者的添加疗法。我们分析了透析结果和实践模式研究（DOPPS）的数据，以检验开始使用司维拉姆与使用钙基磷酸盐结合剂治疗的血液透析患者的生存率改善相关的假设。来自DOPPS III期和IV期（2005-2011）的564例患者，在基线或司维拉姆治疗前接受钙基磷结合剂处方。死亡风险进行了评估，使用顺序分层方法，以确定尚未治疗的患者谁是适当匹配的新治疗的患者的基础上，他们的死亡risk of death.Results的12,564例患者，2606随后用盐酸司维拉姆或碳酸司维拉姆治疗。开始司维拉姆治疗后，平均血清磷水平在前4个月下降0.3 mg/dl，此后逐渐下降。我们将2501名接受治疗的患者与至少一名尚未接受治疗的患者进行了匹配。与尚未接受治疗的患者相比，接受司维拉姆治疗的患者死亡风险降低14%（风险比，0.86; 95%置信区间，0.76 - 0.97）。在敏感性分析中观察到类似的结果时，改变匹配卡尺或治疗和尚未治疗的比率，并通过使用倾向评分matching.Conclusions使用司维拉姆作为钙基磷结合剂的添加或替代治疗与维持性血液透析患者的生存率提高。
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.