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Association between phosphate binder pill burden and mortality risk in patients on maintenance hemodialysis: a single-center cohort study with 7-year follow-up of 513 patients

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Abstract

Background

Dialysis patients often take multiple oral medications, leading to a high pill burden. Phosphate binders (PBs) account for a large proportion of this daily pill burden (DPB). The relationship between DPB and mortality risk remains unclear, and we hypothesized that this relationship might be influenced by the proportion of PBs to all medications.

Methods

We divided DPB into those derived from PBs and non-PB drugs and analyzed the association with mortality risk over a 7-year period in 513 chronic hemodialysis patients using a baseline model.

Results

The median (interquartile range) DPB from all drugs was 15.8 (11.2–21.0) pills/day/patient, and the median ratio of PB pills to all drug pills was 29.3 (13.7–45.9)% at baseline. During a median observation period of 5.2 years, 161 patients (31.4%) died. Kaplan–Meier analysis showed no significant difference in all-cause mortality between PB users and non-users. However, a significant survival advantage was observed in the highest tertile of DPB from PBs compared to the lowest tertile. Conversely, the highest tertile of DPB from non-PB drugs was associated with worse survival. Consequently, the highest tertile of the ratio of PBs to all pills was associated with better survival. This association remained significant even after adjusting for patient characteristics in the Cox proportional hazards model. However, when serum nutritional parameters were included as covariates, the significant association disappeared.

Conclusions

Dialysis patients prescribed a higher rate of PB pills to all medications exhibited a lower mortality risk, possibly due to their better nutritional status.

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Acknowledgements

We thank Ms. Ayako Minegishi (Pharmaceutical Department, Hidaka Hospital, Gunma, Japan) for her valuable advice regarding the drugs prescribed in this study. We also thank Editage (www.editage.com) for English language editing.

Funding

There is nothing to be declare.

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Authors and Affiliations

  1. Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan

    Nobuo Nagano, Chie Zushida, Ayaka Tagahara, Masaaki Miya, Noriko Tamei, Shigeaki Muto, Takaaki Tsutsui, Tetsuo Ando, Tetsuya Ogawa & Kyoko Ito

  2. Department of Medicine, Adachi Medical Center, Tokyo Women’s Medical University, Tokyo, Japan

    Nobuo Nagano & Tetsuya Ogawa

Authors
  1. Nobuo Nagano
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  2. Chie Zushida
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  3. Ayaka Tagahara
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  4. Masaaki Miya
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  6. Shigeaki Muto
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  7. Takaaki Tsutsui
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  8. Tetsuo Ando
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  9. Tetsuya Ogawa
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  10. Kyoko Ito
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Contributions

NN designed the study, analyzed the data, and wrote the first and second draft of the manuscript. KI and TT reviewed and revised the manuscript, and TO is responsible for the final version of the manuscript. CZ, AT, MM, NT, SM, TA, TO, and KI were responsible for drug prescriptions for patients. TO supervised the study. All the authors read and approved the final version of this manuscript.

Corresponding author

Correspondence to Nobuo Nagano.

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Conflict of interest

Consultancies: Nobuo Nagano (Kyowa Kirin Co., Ltd and Sanwa Kagaku Kenkyusho Co., Ltd), Honoraria: Nobuo Nagano (Kyowa Kirin Co., Ltd, Torii Pharmaceutical Co., Ltd, and Kissei Pharmaceutical Co., Ltd.). The other authors have declared that no conflict of interest exists.

Ethical approval

All procedures in studies involving human participants were performed in accordance with the ethical standards of the Hidaka Hospital Medical Ethics Committee (approval number: 348) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study did not include any animal studies performed by any of the authors.

Informed consent

This was a retrospective analysis of drug prescription and routine blood chemistry records. Individual informed consent was not required, because many patients died or were transferred to other hospitals at the time of application to the institutional ethics committee.

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All authors gave consent for publication to the journal.

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Cite this article

Nagano, N., Zushida, C., Tagahara, A. et al. Association between phosphate binder pill burden and mortality risk in patients on maintenance hemodialysis: a single-center cohort study with 7-year follow-up of 513 patients. Clin Exp Nephrol 27, 961–971 (2023). https://doi.org/10.1007/s10157-023-02388-0

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  • DOI: https://doi.org/10.1007/s10157-023-02388-0

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