Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis
Abstract Phosphate binders are the main treatment for hyperphosphatemia in patients with chronic kidney disease, and iron-based phosphate binders have been used with increasing frequency in recent years. This study examined the association of the use of iron-based, rather than non-iron-based, phosph...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2023-09-01
|
| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-43177-9 |
| _version_ | 1797576592698900480 |
|---|---|
| author | Akihito Tanaka Sho Sasaki Hisashi Noma Jui Wang Yoshihiro Onishi Daijo Inaguma |
| author_facet | Akihito Tanaka Sho Sasaki Hisashi Noma Jui Wang Yoshihiro Onishi Daijo Inaguma |
| author_sort | Akihito Tanaka |
| collection | DOAJ |
| description | Abstract Phosphate binders are the main treatment for hyperphosphatemia in patients with chronic kidney disease, and iron-based phosphate binders have been used with increasing frequency in recent years. This study examined the association of the use of iron-based, rather than non-iron-based, phosphate binders with the incidence of cardiovascular events, in a real-world setting. We used data from a cohort comprising representative adult patients on maintenance hemodialysis in Japan. The exposure of interest was the time-varying use of phosphate binders, classified into “iron-based”, “only non-iron-based”, and “no use”. The primary outcome was a composite of cardiovascular events and all-cause deaths. A marginal structural Cox regression model was used to deal with possible time-dependent confounding. Of the 2247 patients from 58 hemodialysis facilities, iron-based and only non-iron-based phosphate binders were used in 328 (15%) and 1360 (61%), respectively, at baseline. Hazard ratios (95% confidence intervals) for iron-based and non-iron-based phosphate binders versus no use of phosphate binders were 0.35 (0.24, 0.52) and 0.44 (0.33, 0.58), respectively. The hazard ratio for iron-based relative to non-iron-based phosphate binders was 0.81 (0.58, 1.13), which was not statistically significant. Further studies are warranted to elucidate whether the use of iron-based phosphate binders reduces the event rate. |
| first_indexed | 2024-03-10T21:55:12Z |
| format | Article |
| id | doaj.art-10dca50dbf3b45d684a9348b5e8ccafd |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-10T21:55:12Z |
| publishDate | 2023-09-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-10dca50dbf3b45d684a9348b5e8ccafd2023-11-19T13:09:04ZengNature PortfolioScientific Reports2045-23222023-09-011311810.1038/s41598-023-43177-9Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysisAkihito Tanaka0Sho Sasaki1Hisashi Noma2Jui Wang3Yoshihiro Onishi4Daijo Inaguma5Department of Nephrology, Nagoya University HospitalSection of Education for Clinical Research, Kyoto University HospitalDepartment of Data Science, The Institute of Statistical MathematicsCollege of Public Health, National Taiwan UniversityInstitute for Health Outcomes & Process Evaluation Research (iHope International)Department of Internal Medicine, Fujita Health University Bantane HospitalAbstract Phosphate binders are the main treatment for hyperphosphatemia in patients with chronic kidney disease, and iron-based phosphate binders have been used with increasing frequency in recent years. This study examined the association of the use of iron-based, rather than non-iron-based, phosphate binders with the incidence of cardiovascular events, in a real-world setting. We used data from a cohort comprising representative adult patients on maintenance hemodialysis in Japan. The exposure of interest was the time-varying use of phosphate binders, classified into “iron-based”, “only non-iron-based”, and “no use”. The primary outcome was a composite of cardiovascular events and all-cause deaths. A marginal structural Cox regression model was used to deal with possible time-dependent confounding. Of the 2247 patients from 58 hemodialysis facilities, iron-based and only non-iron-based phosphate binders were used in 328 (15%) and 1360 (61%), respectively, at baseline. Hazard ratios (95% confidence intervals) for iron-based and non-iron-based phosphate binders versus no use of phosphate binders were 0.35 (0.24, 0.52) and 0.44 (0.33, 0.58), respectively. The hazard ratio for iron-based relative to non-iron-based phosphate binders was 0.81 (0.58, 1.13), which was not statistically significant. Further studies are warranted to elucidate whether the use of iron-based phosphate binders reduces the event rate.https://doi.org/10.1038/s41598-023-43177-9 |
| spellingShingle | Akihito Tanaka Sho Sasaki Hisashi Noma Jui Wang Yoshihiro Onishi Daijo Inaguma Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis Scientific Reports |
| title | Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| title_full | Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| title_fullStr | Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| title_full_unstemmed | Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| title_short | Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| title_sort | effects of iron based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis |
| url | https://doi.org/10.1038/s41598-023-43177-9 |
| work_keys_str_mv | AT akihitotanaka effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis AT shosasaki effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis AT hisashinoma effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis AT juiwang effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis AT yoshihiroonishi effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis AT daijoinaguma effectsofironbasedphosphatebindersonmortalityandcardiovasculareventsinpatientsreceivingmaintenancedialysis |