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Multicenter Study
. 2025 Mar 10;26(1):131.
doi: 10.1186/s12882-025-04058-7.

Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study

Kamolpat Chaiyakittisopon  1   2 , Oraluck Pattanaprateep  3 , Wanchana Ponthongmak  1 , Patratorn Kunakorntham  1   4 , Anan Chuasuwan  5 , Atiporn Ingsathit  1 , Gareth J Mckay  6 , John Attia  7 , Ammarin Thakkinstian  1
Affiliations
Multicenter Study

Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study

Kamolpat Chaiyakittisopon et al. BMC Nephrol. .

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.

Keywords: End stage renal disease; Hyperphosphatemia; Phosphate binders; Real-world evidence; Treatment effect model.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study has been approved by the Ethics Committee of Research, Faculty of Medicine Ramathibodi Hospital (COA. MURA2020/1398) and Bhumibol Adulyadej Hospital (IRB No.100/63). The study was conducted following the Declaration of Helsinki. All authors declared no conflict of interest. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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