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Phosphate Binders and Clinical Outcomes in Patients with Stage 5D Chronic Kidney Disease
Author(s) -
Zoccali Carmine,
Mallamaci Francesca,
CannataAndía Jorge
Publication year - 2015
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12416
Subject(s) - hyperphosphatemia , medicine , kidney disease , intensive care medicine , clinical trial , placebo , medical prescription , disease , clinical endpoint , pharmacology , alternative medicine , pathology
Knowledge informing the prescription and the choice of phosphate binders in end stage kidney disease ( ESKD ) patients has a weak evidentiary base. To date, no placebo‐controlled trial based on meaningful clinical endpoints (death, cardiovascular events, bone fractures) has been performed to test the efficacy of these drugs. By the same token, we still lack solid proof that noncalcium binders afford better clinical outcomes as compared with calcium‐based binders. Without proper trials, clinical decisions about the treatment of hyperphosphatemia rest on experience and contingent clinical judgment. The use of huge doses of calcium‐based binders typically prescribed in the nineties now appears unwarranted. The relationship between phosphate and the risk of death is U shaped and moderate hyperphosphatemia carries just a mild‐to‐moderate risk excess and may not be seen as a compelling indication for the prescription of phosphate binders. Placebo‐controlled randomized clinical trials assessing whether non‐calcium and calcium‐based binders reduce the risk of death and cardiovascular disease events in ESKD patients remain a public health priority.