Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients

Kidney Int. 2007 Mar;71(5):438-41. doi: 10.1038/ Epub 2007 Jan 3.


The risk of death in hemodialysis patients treated with calcium-containing phosphate binders or sevelamer is not known. We assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization. This was a predetermined secondary end point of a randomized clinical trial designed to assess progression of coronary artery calcium (CAC) scores in the two treatment arms. Thirty-four deaths occurred during the follow-up period: 23 in subjects randomized to calcium-containing phosphate binders and 11 in subjects randomized to sevelamer. Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score (P=0.002). Mortality was borderline significantly lower in subjects randomized to sevelamer (5.3/100 patient years, confidence interval (CI) (2.2-8.5) compared to those randomized to calcium-containing binders (10.6/100 patient years, CI 6.3-14.9) (P=0.05). The greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment (P=0.016, hazard ratio 3.1, CI 1.23-7.61). In subjects new to hemodialysis baseline CAC score was a significant predictor of all-cause mortality. Treatment with sevelamer was associated with a significant survival benefit as compared to the use of calcium-containing phosphate binders.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Calcinosis / etiology
  • Calcinosis / prevention & control*
  • Calcium Phosphates / blood
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / prevention & control*
  • Female
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Polyamines / therapeutic use*
  • Renal Dialysis / adverse effects
  • Renal Dialysis / mortality*
  • Sevelamer


  • Calcium Phosphates
  • Polyamines
  • calcium phosphate
  • Sevelamer