Use of phosphate-binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort Study

Shunsuke Yamada, Masanori Tokumoto, Masatomo Taniguchi, Hisako Yoshida, Hokuto Arase, Narihito Tatsumoto, Hideki Hirakata, Takanari Kitazono, Kazuhiko Tsuruya

Research output: Contribution to journalArticle

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 languageEnglish
Article number11387
JournalScientific reports
Volume8
Issue number1
DOIs
Publication statusPublished - Dec 1 2018

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Renal Dialysis
Cohort Studies
Phosphates
Mortality
Infection
Propensity Score
Proportional Hazards Models
Protein-Energy Malnutrition
Nutritional Status
Observational Studies
Randomized Controlled Trials
Confidence Intervals
Incidence
Proteins

All Science Journal Classification (ASJC) codes

  • General

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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 journalArticle

Yamada, Shunsuke ; Tokumoto, Masanori ; Taniguchi, Masatomo ; Yoshida, Hisako ; Arase, Hokuto ; Tatsumoto, Narihito ; Hirakata, Hideki ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Use of phosphate-binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis : The Q-Cohort Study. In: Scientific reports. 2018 ; Vol. 8, No. 1.
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