Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study
Issued Date
2025-12-01
Resource Type
eISSN
14712369
Scopus ID
2-s2.0-105000075653
Pubmed ID
40065267
Journal Title
BMC Nephrology
Volume
26
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Nephrology Vol.26 No.1 (2025)
Suggested Citation
Chaiyakittisopon K., Pattanaprateep O., Ponthongmak W., Kunakorntham P., Chuasuwan A., Ingsathit A., Mckay G.J., Attia J., Thakkinstian A. Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study. BMC Nephrology Vol.26 No.1 (2025). doi:10.1186/s12882-025-04058-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/106827
Title
Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Uncontrolled hyperphosphatemia in end stage renal disease (ESRD) increases the risk of cardiovascular disease (CVD), bone disorders, and premature mortality. Randomized controlled trials show reduced CVD risk of non-calcium-based phosphate-binders (NCBPBs) compared to CBPBs although evidence from real world data is less consistent. This study aimed to compare the effectiveness of NCBPBs, CBPBs, to no phosphate-binder (PB) on mortality and cardiovascular disease in Thai hyperphosphatemic ESRDs. Methods: A retrospective-cohort was conducted by using data from 2 university hospitals between January 2010 and July 2020 (COA. MURA2020/1398 and IRB No.100/63). Primary outcomes were overall survival (OS) and CVD-free time. Secondary outcomes included bone disorders following ESRD. An inverse-probability weighting with regression adjustment was used to assess treatment effects. Results: A total of 8,005 patients were included. Initial CBPBs were associated with both longer OS and CVD-free time compared to no-PBs, while initial treatment with aluminum hydroxide was the highest risk of bone disorders. Patients who received CBPBs-NCBPBs had longest OS, followed by aluminum hydroxide, and CBPBs, with average OS of 13.5, 11.0, and 10.9 years, respectively. The average CVD-free time was longest for the CBPBs-NCBPBs, followed by CBPBs-CBPBs compared to no-PBs. However, these comparisons were insignificantly different. Conclusions: initial hyperphosphatemic ESRD treatment with CBPBs provided longer OS and CVD-free time compared to no-PBs, while aluminum hydroxide was the highest risk of bone disorders. CBPBs followed by NCBPBs achieved the longest OS and CVD-free time, although these were statistical non-significance.