Abstract
The use of phosphate (P)-binders allows hemodialysis patients to take in more protein and thus may maintain a good nutritional status. Protein-energy-malnutrition increases the risk of infection-related death. The association between use of P-binders and the relative risks of infection-related death remains unknown in hemodialysis patients. A total of 2926 hemodialysis patients registered to the Q-Cohort Study was followed up for 4-years. The association between use of P-binders and the risks for infection-related and all-cause mortality were estimated by Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score based approaches. During the follow-up period, 106 patients and 492 patients died of infection and any cause, respectively. Cox proportional hazards models with multivariable adjustments including nutritional confounders showed that the incidence of infection-related death was significantly lower in patients with P-binders use compared with those without (hazard ratio [95% confidence interval] for infection-related mortality 0.63 [0.40–0.99]). The results remained significant even after applying four different propensity score-based analyses. Notably, use of P-binders was associated with a lower risk of all-cause mortality. Further studies including randomized controlled clinical trials and observational studies analyzed by an instrumental variable model will provide more robust evidences for the associations observed in our study.
| Original language | English |
|---|---|
| Article number | 11387 |
| Journal | Scientific reports |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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Use of phosphate-binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis : The Q-Cohort Study. / Yamada, Shunsuke; Tokumoto, Masanori; Taniguchi, Masatomo; Yoshida, Hisako; Arase, Hokuto; Tatsumoto, Narihito; Hirakata, Hideki; Kitazono, Takanari; Tsuruya, Kazuhiko.
In: Scientific reports, Vol. 8, No. 1, 11387, 01.12.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Use of phosphate-binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis
T2 - The Q-Cohort Study
AU - Yamada, Shunsuke
AU - Tokumoto, Masanori
AU - Taniguchi, Masatomo
AU - Yoshida, Hisako
AU - Arase, Hokuto
AU - Tatsumoto, Narihito
AU - Hirakata, Hideki
AU - Kitazono, Takanari
AU - Tsuruya, Kazuhiko
PY - 2018/12/1
Y1 - 2018/12/1
N2 - The use of phosphate (P)-binders allows hemodialysis patients to take in more protein and thus may maintain a good nutritional status. Protein-energy-malnutrition increases the risk of infection-related death. The association between use of P-binders and the relative risks of infection-related death remains unknown in hemodialysis patients. A total of 2926 hemodialysis patients registered to the Q-Cohort Study was followed up for 4-years. The association between use of P-binders and the risks for infection-related and all-cause mortality were estimated by Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score based approaches. During the follow-up period, 106 patients and 492 patients died of infection and any cause, respectively. Cox proportional hazards models with multivariable adjustments including nutritional confounders showed that the incidence of infection-related death was significantly lower in patients with P-binders use compared with those without (hazard ratio [95% confidence interval] for infection-related mortality 0.63 [0.40–0.99]). The results remained significant even after applying four different propensity score-based analyses. Notably, use of P-binders was associated with a lower risk of all-cause mortality. Further studies including randomized controlled clinical trials and observational studies analyzed by an instrumental variable model will provide more robust evidences for the associations observed in our study.
AB - The use of phosphate (P)-binders allows hemodialysis patients to take in more protein and thus may maintain a good nutritional status. Protein-energy-malnutrition increases the risk of infection-related death. The association between use of P-binders and the relative risks of infection-related death remains unknown in hemodialysis patients. A total of 2926 hemodialysis patients registered to the Q-Cohort Study was followed up for 4-years. The association between use of P-binders and the risks for infection-related and all-cause mortality were estimated by Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score based approaches. During the follow-up period, 106 patients and 492 patients died of infection and any cause, respectively. Cox proportional hazards models with multivariable adjustments including nutritional confounders showed that the incidence of infection-related death was significantly lower in patients with P-binders use compared with those without (hazard ratio [95% confidence interval] for infection-related mortality 0.63 [0.40–0.99]). The results remained significant even after applying four different propensity score-based analyses. Notably, use of P-binders was associated with a lower risk of all-cause mortality. Further studies including randomized controlled clinical trials and observational studies analyzed by an instrumental variable model will provide more robust evidences for the associations observed in our study.
UR - http://www.scopus.com/inward/record.url?scp=85050800742&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050800742&partnerID=8YFLogxK
U2 - 10.1038/s41598-018-29757-0
DO - 10.1038/s41598-018-29757-0
M3 - Article
AN - SCOPUS:85050800742
VL - 8
JO - Scientific Reports
JF - Scientific Reports
SN - 2045-2322
IS - 1
M1 - 11387
ER -