MO544: Outcomes Associated With use of Phosphate Binders in Persons With Chronic Kidney Disease Stages 4 and 5 in Spain

Abstract

Abstract BACKGROUND AND AIMS Use of phosphate binders among non-dialysis chronic kidney disease (ND-CKD) patients remains controversial, since clinically relevant benefits have not been fully demonstrated. The goal of this study was to determine patterns of phosphate binders use and its associated outcomes in ND-CKD patients. METHOD PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicentre, open-cohort study of 966 adult patients with non-dialysed CKD stages 4–5 enrolled from 12 centres in Spain. The end of the follow-up was December 2012. At baseline and every 6 months, demographics, comorbidities, treatments and serum biochemical parameters were collected. Patients who received treatment with calcium-based and calcium-free phosphate binders were compared with those who had not. In a prespecified statistical approach, we assessed the association of phosphate binders use with all-cause mortality using time-dependent Cox proportional hazards models. RESULTS Sevelamer was the only calcium-free based binder prescribed during the study. Overall, 515 (53%) patients received some form of binder, with most of them using calcium-based binders (n = 360, 37%) and a minority (n = 111, 11%) using exclusively sevelamer (n = 111, 11%) or a combination of the two (n = 44, 5%). After a median follow-up of 29 months (IQR 13–36 months) there were 181 deaths (19%). Crude overall all-cause mortality was significantly lower in patients receiving sevelamer, but not in those receiving calcium-based binders (Figure). After multivariate adjustment for age, weight, blood pressure, diabetes, comorbidity, vitamin D treatment, renal function and levels of albumin, calcium, phosphorous and PTH, treatment with sevelamer was independently associated with lower mortality [adjusted hazard ratio (HR), 0.44 (95% confidence interval (95% CI), 0.22–0.88); P = 0.02]. Use of calcium-based phosphate binders did not predict death. CONCLUSION The administration of sevelamer is associated with lower all-cause mortality in advanced ND-CKD patient. Clinical trials are warranted to clarify the risks and benefits of phosphate binders in this population.