I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on December 20, 2008, 10:50:00 AM
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Phosphorus-lowering drugs linked to lower mortality in dialysis patients
12/18/2008 10:15:53 AM
For patients on dialysis, taking medications to reduce levels of the mineral phosphorus in the
blood may reduce the risk of death by 25 to 30% , reports a study in the Journal of the American Society of Nephrology.
The drugs were associated with improved survival in new dialysis patients, including those patients with only modest or even no increase in their blood phosphorus levels. "This important finding suggests that perhaps treatment with phosphorus binders should be extended back to patients with less-severe chronic kidney disease," said Myles Wolf, MD, MMSc, of the University of Miami, one of the study authors. "This is a much larger population of patients, virtually all of whom have near-normal blood levels of phosphorus but a markedly increased risk of premature death."
The researchers compared mortality rates in two groups of dialysis patients: 3,555 patients who started treatment with phosphorus binders during the first 90 days after starting dialysis and 5,055 who did not
receive phosphorus-lowering treatment during the same period. During the first year on dialysis, patients treated with phosphorus binders had a significantly lower risk of death-30 percent lower, after adjustment
for other risk factors.
A further analysis compared mortality rates in a large subgroup of treated and untreated patients, who were closely matched in terms of their initial blood phosphorus levels and their likelihood of receiving
phosphorus-lowering treatment. In this "propensity score-matched" analysis, risk of death was 25% lower in patients treated with phosphorus binders. The protective effect of phosphorus binders was smaller, but still significant, in an analysis that excluded patients who died in the first 90 days on dialysis.
High phosphorus levels (hyperphosphatemia) are common in patients with kidney disease. "Because hyperphosphatemia is a risk factor for death, phosphorus binders are widely prescribed to dialysis patients," Wolf said. "Nephrologists have assumed that this treatment strategy will improve the clinical outcomes of our patients, such that the target range for serum phosphate levels in dialysis patients has been lowered
in recent years."
However, these recommendations are based largely on opinion. "Whether treatment with any dietary phosphorus binders versus no treatment would improve survival had never been studied until now," says Wolf. The new results provide an important missing piece of information by showing a lower risk of death in dialysis patients receiving phosphorus binders.
If phosphorus binders improve survival even in new dialysis patients with relatively normal phosphorus levels, then it is possible that they might also be beneficial for the much larger group of patients with
less-advanced kidney disease. "Whereas there are roughly 400,000 dialysis patients in the US, there are estimated to be more than 15 million patients with less severe CKD," adds Dr. Wolf. "These patients
are typically not considered for treatment with phosphorus binders, which are approved by the FDA only for use on dialysis. If further studies could demonstrate a similar survival benefit of binders in
patients with pre-dialysis CKD, the results could have a significant impact on the public health."
The study has some important limitations. Since it was not a randomized trial, it is prone to certain forms of bias and confounding. Other limitations include the limited (one year) follow-up and the lack of data on patients' dietary phosphorus intake and whether they actually took their prescribed phosphorus binders.
Wolf has received research support from Shire and honoraria from Genzyme, Abbott and Ineos. The study appears online. http://jasn.asnjournals.org/
http://www.nephronline.com/news.asp?N_ID=2569
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What the...? I started on binders a year or so before I started dialysis and have had them every since and my levels are really good... I can't conceive of someone starting dialysis and NOT being put on some kind of binder?!?
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I have a friend whose mother is on d for about 6 months, doesn't follow her diet and no binders...I have no clue what is going on there, but she doesn't go to d half the time so can't help there..I have pushed to get binders etc but no luck. I feel like I live on my binders but phos last week was 3....yippeeeee.
Ann
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Will have to come back and read this one.
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I think some people on daily or nocturnal D don't take phos binders.
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What the...? I started on binders a year or so before I started dialysis and have had them every since and my levels are really good... I can't conceive of someone starting dialysis and NOT being put on some kind of binder?!?
I suppose it might depend on what the persons predialysis levels were.
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My husband started Tums almost two years before he went on dialysis and was on Renagel for about the last 6 months before dialysis. During this period I had to push for information on the renal diet and guidelines for how much phosphorus was acceptable in the period before dialysis. It was difficult to get an answer and we never were referred to the dietician.
After his nephrectomies my husband was prescribed one Renagel with each meal and struggled to get his phosphorus into range, even though we were following the renal diet very strictly. That was at about the same time I discovered IHD and learned that others were adjusting their binder intake to in order to give them a little flexibility in the diet - i.e. determining how many binders to take based on the phosphorus content in the meal.
As far as I am aware, my husband's neph never said anything to him about adjusting his binder intake. In retrospect, I wonder if they first wanted him to work on making the dietary changes. On the other hand, they knew he was scheduled for a transplant 7 weeks later, so why not make things a little easier?
I can't imagine folks not taking their binders at all, but I'm also convinced that patient education is not what it should be.
Thank goodness for IHD!
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Well I'll be buggered - read the article and the posts and now I'm confused :stressed;
My Dad has been on dialysis for 7 months and does not take binders of any kind
He was on Calcitrol (or something like that) but they stopped them a month ago
Now I am wondering what is going on with poor Dad and his medical advice he is receiving here in bloody woop woop with the f#%ken neph
:Kit n Stik; :Kit n Stik;
Doesn't taking binders or not taking binders dependent on your blood results?
Anyway that's what the bloody idiots at Dad's clinic said.
Would appreciate some advice IHD mob.
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It absolutely does depend on his blood results and in fact one of the patients at my clinic has to try to eat more phosphorus because she's low. The binders absorb the phosphorus and Tums or calcium work for some but for others their calcium goes too high so something else, like Renagel, is needed. It has to be individualized. There is no one size fits all dialysis.
Don't kill those people yet with that big stick girl. LOL
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Don't kill those people yet with that big stick girl. LOL
:rofl;
okay
thanks mate for the info - bless ya cotton socks
:thx;
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http://www.kidneyschool.org/mod_07/mod7_21.shtml
A bit more info for you mate. LOL. Feels really funny calling you that, like I've joined the Navy or something.
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http://www.kidneyschool.org/mod_07/mod7_21.shtml
A bit more info for you mate. LOL. Feels really funny calling you that, like I've joined the Navy or something.
:rofl;
won't be long 'til we have you eating meat pies with dead horse and kicking an aussie rules football
The link is very informative - :thx; mate :cuddle; :beer1;
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I agree Monrein, but I think one point of the article is that it might be better to control the phosphorus a little earlier on (do you read it that way?). It made me think of the way they've changed on blood pressure recommendations. The target numbers keep coming down.
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Well Jessup it does depend on your dad's labs - everyone is different - I guess if he is in the OK range for phosphate without the binders than he is good, so his figure should be < 1.4 and he is OK. Do you ever get to see his lab results?
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I think some people on daily or nocturnal D don't take phos binders.
That's me. Phosphorus is at 5, and I don't restrict my diet or take binders.
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clearly daily dialysis will reduce and in most cases eliminate the need for binders and fluid/dietry restrictions because you're dialyzing enough to take everything off without much harm. I guess this is all only relevant for those that do in-centre(or home) hemo 3x/week which is getting far less dialysis to the kidneys than those doing nxstage/nocturnal nightly.