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. 2020 Oct 30;15(10):e0241435.
doi: 10.1371/journal.pone.0241435. eCollection 2020.

Effects of calcium-containing phosphate binders on cardiovascular events and mortality in predialysis CKD stage 5 patients

Ping-Huang Tsai  1 , Chi-Hsiang Chung  2   3 , Wu-Chien Chien  2   4   5 , Pauling Chu  1
Affiliations

Effects of calcium-containing phosphate binders on cardiovascular events and mortality in predialysis CKD stage 5 patients

Ping-Huang Tsai et al. PLoS One. .

Abstract

Background: Hyperphosphatemia and calcium load were associated with vascular calcification. The role of calcium-containing phosphate binders (CCPBs) use as important determinants of death and cardiovascular events in predialysis hyperphosphatemic chronic kidney disease (CKD) patients remain unclear due to the absence of evidence for reduced mortality with CCPB use compared with placebo. We aimed to investigate the effect of using CCPBs or nonuse in all-cause mortality rates and cardiovascular events in CKD stage 5 patients between 2000 and 2005 in the Taiwanese National Health Insurance Research Database.

Methods: Patients with known coronary heart disease and those who had undergone dialysis or renal transplantation were excluded. The CCPB users were matched with nonusers by the propensity score model. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) of all-cause mortality and cardiovascular events.

Results: During a mean follow-up of 4.58 years, 879 CCPB users were matched with 3516 nonusers. CCPB use was an independent risk factor for cardiovascular events [adjusted hazard ratio (HR) 1.583, 95% confidence interval (CI) 1.393-1.799]. The increased cardiovascular risk was dose-dependent and consistent across all subgroup analyses. Compared with no use, CCPB use was associated with no significant all-cause mortality risk (1.74 vs. 1.75 events per 100 person-years, adjusted HR 0.964, 95% CI 0.692-1.310).

Conclusions: CCPB use in CKD stage 5 patients was associated with a significantly increased cardiovascular event risk compared with the nonusers, whereas the all-cause mortality risk was similar between the two groups. Whether these relationships are causal require further randomized controlled trials.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study profile.
aNumbers for exclusions may not sum because of patients fulfilling more than one criterion. bPatients in the treated cohort (received CCPB for ≥ 90 days) were matched at a ratio of 1:4 with those in the untreated cohort (never received CCPB) by means of propensity scores. Abbreviations: CKD, chronic kidney disease; ESA, erythropoiesis-stimulating agent; CCPB, calcium-containing phosphate binder.
Fig 2
Fig 2
Kaplan–Meier Curves for the Cumulative Incidence of (A) Coronary Heart Disease and (B) All-cause Mortality with Calcium-containing Phosphate Binder Use. Comparison of the cumulative incidence of coronary heart disease and all-cause mortality were shown. P values<0.05 were considered statistically significant.
Fig 3
Fig 3
Multivariable Stratified Analyses of the Association Between Calcium-containing Phosphate Binder Use and (A) Coronary Heart Disease Development and (B) All-cause Mortality. Hazard ratios from the subgroup analysis for coronary heart disease and all-cause mortality between CCPBs user and nonuser were shown.
See this image and copyright information in PMC

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