Block GA et al. (2007) Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 71: 438–441

Extensive coronary artery calcification (CAC) is common in people on hemodialysis. Sevelamer, a phosphate binder that does not contain calcium, is associated with slower progression of CAC than are calcium-containing phosphate binders. A recent study has investigated the effect of phosphate binder choice on the risk of death in hemodialysis patients.

All-cause mortality was assessed in 127 patients new to hemodialysis who had been enrolled in a randomized trial comparing CAC progression in patients on sevelamer (n = 60) with that in patients taking calcium-containing binders (n = 67).

After a median follow-up of 44 months, 34 patients had died (11 patients in the sevelamer group and 23 patients in the calcium-containing binder group). Mortality rates were higher in patients who received calcium-containing phosphate binders than in sevelamer-treated patients (10.6/100 patient-years vs 5.3/100 patient-years; P = 0.05). Baseline CAC score was a significant predictor of mortality; patients with no evidence of CAC at baseline had a significantly lower mortality rate than did patients with scores of 1–400 and those with scores >400 (mortality rates 3.3/100 patient-years, 7.0/100 patient-years and 14.7/100 patient-years, respectively; P = 0.002). Multivariable analysis adjusted for factors such as age, race, gender and baseline CAC score showed that patients treated with calcium-containing binders had a threefold higher risk of death than did sevelamer-treated patients (hazard ratio 3.1; P = 0.016).