Secondary analysis of the RIND study presented some additional results.
Block GA, Raggi P, Bellasi A, Kooienga L, & Spiegel DM. Mortality effect of coronary calcification & phosphate binder choice in incident hemodialysis patients. Kidney International advance online publication, 3 January 2007;doi:10.1038/sj.ki.5002059:1-4
Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients
Background
Patients undergoing hemodialysis have extensive coronary artery calcification (CAC) compared to patients with normal kidney function. Calcium-containing phosphate binders have been associated with a rapidly progressive increase in the extent of CAC in the RIND study.
Trial Design
This study reports on the original RIND trial, evaluating if the choice of phosphate binder impacts clinical outcomes.
Population
The study population was 127 patients new to hemodialysis with similar baseline characteristics. See RIND population for further details.
Intervention/Comparator
Sevelamer hydrochloride was compared to calcium-containing phosphate binders. Subjects remained on their assigned phosphate binder during the original trial's study period (i.e. 18 months) and afterwards phosphate binders were changed at the discretion of their primary nephrologist. Subjects were followed for a total of 44 months.
Outcomes
This study aimed to explore the effect of phosphate binder on all-cause mortality.
Results
Eleven deaths occurred in the sevelamer group and twenty-three deaths in the calcium binder group. Mortality was significantly higher in patients treated with calcium binders (10.6/100 patient years versus 5.3/100 patient years, p=0.05). Mortality was significantly increased in calcium-treated patients (HR 3.1, p=0.02) after multivariable adjustment (i.e. for age, race, gender, diabetes, albumin, history of atherosclerotic cardiovascular disease, and baseline CAC score).
Limitations
This study has similar limitations to the original study, which are small sample size, short duration and no control for lipid levels or vitamin D.
Bottom Line
The presence and severity of coronary artery calcification (CAC) is a predictor of all-cause mortality in incident hemodialysis patients. Sevelamer appears to reduce the risk of mortality in the hemodialysis population.
Block GA, Raggi P, Bellasi A, Kooienga L, & Spiegel DM. Mortality effect of coronary calcification & phosphate binder choice in incident hemodialysis patients. Kidney International advance online publication, 3 January 2007;doi:10.1038/sj.ki.5002059:1-4
Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients
Background
Patients undergoing hemodialysis have extensive coronary artery calcification (CAC) compared to patients with normal kidney function. Calcium-containing phosphate binders have been associated with a rapidly progressive increase in the extent of CAC in the RIND study.
Trial Design
This study reports on the original RIND trial, evaluating if the choice of phosphate binder impacts clinical outcomes.
Population
The study population was 127 patients new to hemodialysis with similar baseline characteristics. See RIND population for further details.
Intervention/Comparator
Sevelamer hydrochloride was compared to calcium-containing phosphate binders. Subjects remained on their assigned phosphate binder during the original trial's study period (i.e. 18 months) and afterwards phosphate binders were changed at the discretion of their primary nephrologist. Subjects were followed for a total of 44 months.
Outcomes
This study aimed to explore the effect of phosphate binder on all-cause mortality.
Results
Eleven deaths occurred in the sevelamer group and twenty-three deaths in the calcium binder group. Mortality was significantly higher in patients treated with calcium binders (10.6/100 patient years versus 5.3/100 patient years, p=0.05). Mortality was significantly increased in calcium-treated patients (HR 3.1, p=0.02) after multivariable adjustment (i.e. for age, race, gender, diabetes, albumin, history of atherosclerotic cardiovascular disease, and baseline CAC score).
Limitations
This study has similar limitations to the original study, which are small sample size, short duration and no control for lipid levels or vitamin D.
Bottom Line
The presence and severity of coronary artery calcification (CAC) is a predictor of all-cause mortality in incident hemodialysis patients. Sevelamer appears to reduce the risk of mortality in the hemodialysis population.