Patient survival and the combination of vitamin D and phosphorus binder in dialysis

Abstract

OBJECTIVE: Treatment with either vitamin D or phosphorus binder alone improves the survival of dialysis patients. This multicenter observational study investigated whether a combination of these drugs was related to prognosis in Japanese dialysis patients. METHODS: Maintenance dialysis patients (n = 466) were registered in 2003 and followed for up to 5 years. Group survival according to their use of vitamin D and phosphorous binder were compared using Cox-proportional hazard analysis. RESULTS: During the follow-up period, 132 deaths (63 cardiovascular and 69 non-cardiovascular deaths) occurred. Compared with the patients who used vitamin D and phosphorus binder concomitantly (n = 269), all-cause mortality was higher in patients using neither drug (n = 36, hazard ratio [HR] 3.53, 95% CI 1.39-8.94, p = 0.008), using phosphorus binder alone (n = 115, HR 2.16, 95% CI 1.19-3.90, p = 0.011), and using vitamin D alone (n = 46, HR 1.38, 95% CI 0.55-3.46, p = 0.496) after adjustment with possible confounders. The advantage for patients who used both drugs concomitantly was also significant in cardiovascular mortality, but not in non-cardiovascular mortality. CONCLUSIONS The combination of vitamin D and phosphorus binder was significantly related to survival in dialysis patients. © 2010 Wiley-Liss, Inc.