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Cannata-Andía, Jorge B.; Fernández-Martín, José L.; Locatelli, Francesco; London, Gérard; Gorriz, José L.; Floege, Jürgen; Ketteler, Markus; Ferreira, Aníbal; Covic, Adrian; Rutkowski, Boleslaw; Memmos, Dimitrios; Bos, Willem-Jan; Teplan, Vladimir; Nagy, Judit; Tielemans, Christian; Verbeelen, Dierik; Goldsmith, David; Kramar, Reinhard; Martin, Pierre-Yves; Wüthrich, Rudolf P.; Pavlovic, Drasko; Benedik, Miha; Sánchez, José Emilio; Martínez-Camblor, Pablo; Naves-Díaz, Manuel; Carrero, Juan J.; Zoccali, Carmine
Kidney international, 11/2013, Letnik: 84, Številka: 5Journal Article
Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix–adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models. Three different multivariate models that included up to 24 variables were used for adjustments. After multivariate analysis, patients prescribed phosphate-binding agents showed a 29 and 22% lower all-cause and cardiovascular mortality risk, respectively. The survival advantage of phosphate-binding agent prescription remained statistically significant after propensity score matching analysis. A decrease of 8% in the relative risk of mortality was found for every 10% increase in the case-mix–adjusted facility prescription of phosphate-binding agents. All single and combined therapies with phosphate-binding agents, except aluminum salts, showed a beneficial association with survival. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of phosphate-binding agents on mortality.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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