Original InvestigationDialysisPhosphate Binder Use and Mortality Among Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS): Evaluation of Possible Confounding by Nutritional Status
Section snippets
Data Source
Data were from phases I-III of the DOPPS, an international prospective cohort study in 12 countries.12, 13 The DOPPS is based on nationally representative samples of randomly selected dialysis facilities and patients. Within each participating facility, 20-40 patients were randomly selected, depending on facility size. Institutional review boards in each country approved the study, and informed patient consent was obtained in accordance with local requirements.
The main analyses were based on
Patient Characteristics by Phosphate Binder Prescription
Patient characteristics by phosphate binder prescription and ORs for phosphate binder prescription by patient characteristic are listed in Table 1 for the 23,898 maintenance HD patients receiving HD for at least 90 days at study entry. Patients prescribed phosphate binders represented 88.1% of the sample. Patients prescribed a phosphate binder had a lower prevalence of several comorbid conditions and a profile consistent with better nutritional status for each of the 5 nutritional measures:
Discussion
Results of this large international prospective cohort study indicate greater survival for maintenance HD patients prescribed a phosphate binder and in facilities with a higher percentage of patients with a phosphate binder prescription. Sensitivity analyses suggest a similar survival benefit in prevalent and incident maintenance HD patients. The longer first-year survival associated with phosphate binder prescription in incident maintenance HD patients is consistent with results from a
Acknowledgements
Initial research was presented as an abstract entitled “Phosphate binder use and mortality among hemodialysis (HD) patients in the DOPPS: influence of nutritional adjustment” at Renal Week 2009, October 27-November 1, San Diego, CA.
Support: The DOPPS is administered by Arbor Research Collaborative for Health and is supported by scientific research grants from Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in Japan), Sanofi/Genzyme (since 2009), Abbott (since 2009), Baxter (since 2011), and
References (30)
- et al.
Simple nutritional indicators as independent predictors of mortality in hemodialysis patients
Am J Kidney Dis
(1998) - et al.
Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Am J Kidney Dis
(2008) - et al.
Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study
Am J Kidney Dis
(1998) - et al.
Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
J Ren Nutr
(2010) - et al.
Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease?
Am J Clin Nutr
(2008) - et al.
The Kidney Disease: Improving Global Outcomes website: comparison of guidelines as a tool for harmonization
Kidney Int
(2007) - et al.
The Dialysis Outcomes and Practice Patterns Study (DOPPS): an international hemodialysis study
Kidney Int Suppl
(2000) - et al.
The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology
Am J Kidney Dis
(2004) - et al.
Outcomes associated with phosphorus binders in men with non-dialysis-dependent CKD
Am J Kidney Dis
(2010) - et al.
Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis
Am J Kidney Dis
(2011)
Serum creatinine improves body mass index survival prediction in hemodialysis patients: a 1-year prospective cohort analysis from the ARNOS Study
J Ren Nutr
Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study
Lancet
Lack of appetite in haemodialysis patients—associations with patient characteristics, indicators of nutritional status and outcomes in the international DOPPS
Nephrol Dial Transplant
K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease
Am J Kidney Dis
Prescribed dietary phosphate restriction and survival among hemodialysis patients
Clin J Am Soc Nephrol
Cited by (0)
Originally published online March 5, 2012.