Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients

• Published in: Kidney international Vol. 71; no. 5; pp. 438 - 441
• Main Authors: Block, G.A., Raggi, P., Bellasi, A., Kooienga, L., Spiegel, D.M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2007; Elsevier Limited
• Subjects: Adult; Aged; Calcinosis - etiology; Calcinosis - prevention & control; Calcium Phosphates - blood; coronary artery calcification; Coronary Artery Disease - etiology; Coronary Artery Disease - prevention & control; Female; hemodialysis; Humans; Kidney Failure, Chronic - therapy; Male; Middle Aged; mortality; phosphate binders; Polyamines - therapeutic use; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Sevelamer; hemodialysis; mortality; phosphate binders; sevelamer; coronary artery calcification
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5002059

The risk of death in hemodialysis patients treated with calcium-containing phosphate binders or sevelamer is not known. We assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization. This was a predetermined secondary end point of a randomized clinical trial designed to assess progression of coronary artery calcium (CAC) scores in the two treatment arms. Thirty-four deaths occurred during the follow-up period: 23 in subjects randomized to calcium-containing phosphate binders and 11 in subjects randomized to sevelamer. Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score (P=0.002). Mortality was borderline significantly lower in subjects randomized to sevelamer (5.3/100 patient years, confidence interval (CI) (2.2–8.5) compared to those randomized to calcium-containing binders (10.6/100 patient years, CI 6.3–14.9) (P=0.05). The greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment (P=0.016, hazard ratio 3.1, CI 1.23–7.61). In subjects new to hemodialysis baseline CAC score was a significant predictor of all-cause mortality. Treatment with sevelamer was associated with a significant survival benefit as compared to the use of calcium-containing phosphate binders.