Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis

• Published in: Journal of clinical medicine 2023-12, Vol.12 (24), p.7631
• Main Authors: Molina, Pablo, Molina, Mariola D, Carrero, Juan J, Escudero, Verónica, Torralba, Javier, Castro-Alonso, Cristina, Beltrán, Sandra, Vizcaíno, Belén, González-Moya, Mercedes, Kanter, Julia, Sancho-Calabuig, Asunción, Bover, Jordi, Górriz, José L
• Format: Article
• Language: English
• Subjects: Antihypertensives; Cardiovascular disease; Cardiovascular diseases; Chronic kidney failure; Clinical medicine; Diabetes; Drug therapy; Health aspects; Heart failure; Hemodialysis; Hypertension; Kidney diseases; Laboratories; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Mortality; Patient outcomes; Patients; Phosphates; Risk factors; Sevelamer carbonate; Statistics; Variables
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12247631

Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Our research is presented in a prospective cohort study. A total of 966 participants with NDD-CKD stages 4-5 were enrolled in the PECERA study from 12 centers in Spain. The participants were treated with sevelamer. This study yielded all-cause and cardiovascular mortality outcomes. We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. After a median follow-up of 29 months (IQR: 13-36 months), death occurred in 181 participants (19%), with cardiovascular ( = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. : In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.