Kidney Week

Abstract: TH-PO166

Pill Burden and Clinical Outcomes in Patients with Hyperphosphatemia Undergoing Hemodialysis

Session Information

• CKD-MBD: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Yoshida, Kiryu, Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan

Kiryu Yoshida, MD, PhD

• Saito, Tomohiro, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan

Tomohiro Saito, MD, PhD

• Kato, Tadashi, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan

Tadashi Kato, MD, PhD

• Kato, Noriyuki, Saiyu Clinic, Saitama, Japan

Noriyuki Kato, PhD

• Mizobuchi, Masahide, Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan

Masahide Mizobuchi, MD, PhD

• Ogata, Hiroaki, Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan

Hiroaki Ogata, MD, PhD

• Koiwa, Fumihiko, Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan

Fumihiko Koiwa, MD, PhD

• Honda, Hirokazu, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan

Hirokazu Honda, MD, PhD

Background

Phosphate binders (PB) improve clinical outcomes in HD patients; however, high pill burden might impair PB adherence. This study assesses association between the number of prescribed PB and clinical outcomes in patients on HD.

Methods

A retrospective study using data from 395 HD patients in a single facility in Japan, from August 2018 to November 2023. Outcomes include cardiovascular events (CVE), all-cause mortality, and fractures. Cox proportional hazards models were used to assess the relationship between PB pill count and outcomes. Baseline analysis and time-averaged analysis were performed.

Results

Patients were divided into tertiles based on baseline daily PB pill count: <4 (T1), 4-8 (T2), and ≥9 pills/day (T3), respectively. For CVE, the baseline analysis showed that, compared to T3, the hazard ratio (HR) for T1 was 0.66 (95% CI: 0.43-1.02, p=0.062) and for T2 was 0.49 (95% CI: 0.29-0.80, p=0.005). The time-averaged analysis revealed that the HR for T1 was 0.44 (95% CI: 0.27-0.71, p=0.001) and for the T2 was 0.45 (95% CI: 0.29-0.69, p<0.001). In patients with serum phosphate levels <5.2 mg/dL, the baseline analysis indicated that the HR for T1 was 0.53 (95% CI: 0.26-1.06, p=0.074) and for T2 was 0.39 (95% CI: 0.19-0.81, p=0.011). There were no significant differences in HR for all-cause mortality and fractures among the three groups.

Conclusion

A higher pill burden of PB might be associated with an increased risk of CVE, even in patients with well-controlled phosphate levels.