Clinical Effectiveness of Phosphate Binders for Treating Hyperphosphatemia in End-Stage Renal Disease Patients: A Multicenter Real-World Study

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 evaluate the effectiveness of phosphate-binders (PB) in Thai hyperphosphatemic ESRDs. A retrospective-cohort was conducted by using data from 2 university hospitals between January 2010 and July 2020. 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. 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. In 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.