@article{7253bccda6434592996aa0bf21a8ee34,
title = "Use of phosphate-binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort Study",
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.",
author = "Shunsuke Yamada and Masanori Tokumoto and Masatomo Taniguchi and Hisako Yoshida and Hokuto Arase and Narihito Tatsumoto and Hideki Hirakata and Takanari Kitazono and Kazuhiko Tsuruya",
note = "Funding Information: We would like to thank all the doctors and medical staffs who participated in the Q-Cohort Study. The following personnel (institutions) participated in this trial: Takashi Ando (Hakozaki Park Internal Medicine Clinic); Takashi Ariyoshi (Ariyoshi Clinic); Kouichiro Goto (Goto Clinic); Fumitada Hattori (Nagao Hospital); Harumichi Higashi (St Mary{\textquoteright}s Hospital); Tadashi Hirano (Hakujyuji Hospital); Kei Hori (Munakata Medical Association Hospital); Takashi Inenaga (Ekisaikai Moji Hospital); Hidetoshi Kanai (Kokura Memorial Hospital); Shigemi Kiyama (Kiyama Naika); Tetsuo Komota (Komota Clinic); Hiromasa Kuma (Kuma Clinic); Toshiro Maeda (Kozenkai-Maeda Hospital); Junichi Makino (Makino Clinic); Dai Matsuo (Hirao Clinic); Chiaki Miishima (Miishima Naika Clinic); Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital); Kenichi Motomura (Motomura Naika Clinic); Sadatoshi Nakamura (Kokura Daiichi Hospital); Hidetoshi Nakamura (Kokura Daiichi Hospital); Koichi Nakashima (Ohashi Internal Circulatory Clinic); Nobumitsu Okita (Shiroishi Kyoritsu Hospital); Shinichiro Osato (Osato Jin Clinic); Sakura Sakamoto (Fujiyamato Spa Hospital); Keiko Shigematsu (Shigematsu Clinic); Kazumasa Shimamatsu (Shimamatsu Naika Iin); Yoshito Shogakiuchi (Shin-Ai Clinic); Hiroaki Takamura (Hara Hospital); Kazuhito Takeda (Iizuka Hospital); Asuka Terai (Chidoribashi Hospital); Hideyoshi Tanaka (Mojiko-Jin Clinic); Suguru Tomooka (Hakozaki Park Internal Medicine Clinic); Jiro Toyonaga (Fukuoka Renal Clinic); Hiroshi Tsuruta (Steel Memorial Yawata Hospital); Ryutaro Yamaguchi (Shiseikai Hospital); Taihei Yanagida (Saiseikai Yahata General Hospital); Tetsuro Yanase (Yanase Internal Medicine Clinic); Tetsuhiko Yoshida (Hamanomachi Hospital); Takahiro Yoshimitsu (Gofukumachi Kidney Clinic, Harasanshin Hospital); Koji Yoshitomi (Yoshitomi Medical Clinic). The Q-Cohort Study is supported by The Kidney Foundation, Japan (H19 JKFB 07-13, H20 JKFB 08-8, H23 JKFB 11-11) and The Japan Dialysis Outcome Research Foundation (H19-076-02 and H20-003), without restriction on publications. We thank Susan Furness, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. Publisher Copyright: {\textcopyright} 2018, The Author(s).",
year = "2018",
month = dec,
day = "1",
doi = "10.1038/s41598-018-29757-0",
language = "English",
volume = "8",
journal = "Scientific Reports",
issn = "2045-2322",
publisher = "Nature Publishing Group",
number = "1",
}