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document
Effects of phosphorus-restricted diet and phosphate-binding therapy on outcomes in patients with chronic kidney disease . BACKGROUND Phosphorus is associated with mortality in patients with chronic kidney disease ( CKD ) not on dialysis , possibly through phosphorus-dependent vascular calcification . Although a phosphorus-restricted diet reduces serum phosphorus , it is unlikely that it reduces vascular calcification progression in CKD . This study evaluated whether a combined strategy of phosphorus-restricted diet and phosphate-binding therapy can reduce the risk of all-cause mortality and/or dialysis initiation by attenuating coronary artery calcification ( CAC ) progression in non-dialysis CKD patients . METHODS This was a post hoc analysis of a subgroup of patients from a study that evaluated the impact of two phosphorus binder regimens on hard outcomes in CKD . Patients ( n = 113 ) with stage 3-4 CKD and evidence of CAC on a phosphorus-restricted diet were randomized to receive either calcium carbonate or sevelamer added to their phosphorus-restricted diet . End-points were death for any cause and initiation of dialysis . Patients were monitored to the first event or to conclusion of the 36-month follow-up . RESULTS Overall , treatment with calcium carbonate was associated with increased CAC progression and occurrence of all-cause mortality , dialysis initiation , and the composite end-point . After adjustment for confounders , sevelamer use was the only independent predictive factor of reduced risk of each endpoint but only if CAC progression was either absent or moderate . Accelerated progression ( annual CAC increase > 75th percentile of the study cohort ) increased the risk of all-cause mortality and composite end-point ( p = 0.01 ) independently of the use of sevelamer . CONCLUSIONS A significant reduction in all-cause mortality , dialysis initiation , and composite end-point risk was achieved by combining phosphorus-restricted diet and sevelamer in non-dialysis CKD patients with absent or moderate but not accelerated CAC progression . Future studies should investigate the role of serum phosphorus , the usefulness of a phosphorus-restricted diet , and the appropriateness of current normal ranges of serum phosphorus concentration in relation to events in non-dialyzed CKD patients .
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Intervention_Pharmacological
phosphorus-restricted diet
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Intervention_Pharmacological
phosphate-binding therapy
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Intervention_Pharmacological
phosphorus-restricted diet
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Intervention_Pharmacological
combined strategy of phosphorus-restricted diet
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Intervention_Pharmacological
phosphate-binding therapy
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Outcome_Mortality
risk of all-cause mortality
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Outcome_Physical
dialysis initiation
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Outcome_Physical
coronary artery calcification ( CAC ) progression
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Participant_Condition
patients with chronic kidney disease
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Participant_Condition
patients with chronic kidney disease
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Participant_Condition
CKD
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Participant_Condition
non-dialysis CKD patients
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Participant_Sample-size
113
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Participant_Condition
CAC
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Participant_Condition
CKD