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. 2022 Oct;27(10):834-844.
doi: 10.1111/nep.14088.

Impact of phosphate binders on quality of life in dialysis patients: Results from the prospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes study

Julia M T Colombijn  1   2   3 , Sanne Vonk  2 , Tom Cornelis  4 , Siska Boorsma  5 , Marielle M E Krekels  6 , Alferso C Abrahams  2 , Brigit C van Jaarsveld  1   7
Affiliations

Impact of phosphate binders on quality of life in dialysis patients: Results from the prospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes study

Julia M T Colombijn et al. Nephrology (Carlton). 2022 Oct.

Abstract

Background: Phosphate binders cause high pill burden for dialysis patients, complicate medication regimens, and have unpleasant taste and large size which may affect patients' quality of life. This study explores the association between phosphate binder pill burden and health-related quality of life (HRQoL) in dialysis patients.

Methods: We conducted a cross-sectional multi-centre cohort study in 21 Dutch dialysis centres. Phosphate binder pill burden was extracted from electronic patient records. Primary outcome was HRQoL measured with the Short Form 12 physical and mental component summary scores (PCS and MCS). Secondary endpoints were severity of gastro-intestinal symptoms, itching, dry mouth, and mental health symptoms, measured with the Dialysis Symptom Index.

Results: Of 388 included patients, aged 62 ± 16 years, 77% underwent haemodialysis. PCS scores were comparable for patients with and without phosphate binders. Patients using 1-3 pills reported lower scores for decreased appetite (β -0.5; 95%CI -0.9 to -0.2), implying better appetite, than patients without phosphate binders. Patients using 4-6 pills also reported lower scores for decreased appetite (β -0.5; 95%CI -0.8 to -0.1) and for itching (β -0.5; 95%CI -0.9 to -0.1). Patients using >6 pills reported lower MCS (β -2.9; 95%CI -6.2-0.4) and higher scores for feeling nervous (β 0.6; 95%CI 0.1-1.1) and feeling sad (β 0.4; 95%CI 0.0-0.9).

Conclusion: Phosphate binder pill burden is not associated with physical quality of life. A higher pill burden is associated with better appetite and less itching. Patients using >6 pills per day report lower mental quality of life and felt nervous and sad more often.

Keywords: dialysis; phosphate binders; phosphate binding agents; polypharmacy; quality of life.

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Figures

FIGURE 1
FIGURE 1
Flow chart of participant selection
FIGURE 2
FIGURE 2
Overview of frequency of the prescription of different combinations of phosphate binding agents at 3 months after start of dialysis. Other combinations: sucroferric oxyhydroxide (n = 2), calcium carbonate + sevelamer + calcium acetate/magnesium carbonate (n = 2), calcium carbonate + calcium acetate/magnesium carbonate (n = 1), sevelamer + sucroferric oxyhydroxide (n = 1), lanthanum carbonate + calcium acetate/magnesium carbonate (n = 1), calcium carbonate + sevelamer + calcium acetate/magnesium carbonate (n = 1), and calcium carbonate + sevelamer + sucroferric oxyhydroxide (n = 1)
FIGURE 3
FIGURE 3
Association between phosphate binder pill burden and Physical and Mental Component Summary score
FIGURE 4
FIGURE 4
Prevalence and severity of gastro‐intestinal and mental‐health related symptoms, and itching, and dry mouth by phosphate binder pill burden at 3 months after the start of dialysis
See this image and copyright information in PMC

References

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