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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Am+J+Kidney+Dis 2014 ; 64 (1): 95-103 Nephropedia Template TP
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Comparative Effectiveness of Calcium Acetate and Sevelamer on Clinical Outcomes in Elderly Hemodialysis Patients Enrolled in Medicare Part D #MMPMID24387795
Yusuf AA; Weinhandl ED; St. Peter WL
Am J Kidney Dis 2014[Jul]; 64 (1): 95-103 PMID24387795show ga
Background: Phosphate binders are an important therapeutic option for managing hyperphosphatemia in hemodialysis patients. Whether sevelamer confers a survival advantage over calcium acetate is unclear. Study Design: Observational cohort study using US Renal Data System (USRDS) data linked to Medicare Part D prescription drug data. Setting & Participants: Medicare-enrolled, elderly, incident hemodialysis patients initiating calcium acetate or sevelamer between July 1, 2006, and March 31, 2011. Predictor: Prescription for sevelamer (hydrochloride or carbonate) or calcium acetate. Outcomes & measurements: All-cause and cardiovascular-related mortality, hospital admissions and hospital days assessed from Medicare Parts A, B, and D claims and other USRDS data. Results: The sevelamer and calcium acetate groups included 16,916 and 18,335 patients, respectively. After multivariable adjustment, all-cause (21.9 versus 21.8 deaths per 100 patient-years; adjusted HR, 0.97; 95% CI, 0.94-1.03) and cardiovascular (8.7 versus 8.6 deaths per 100 patient-years; HR, 0.99; 95% CI, 0.93-1.04) mortality did not differ significantly between the sevelamer group and calcium acetate group (referent). Mortality results in propensity-score matched cohorts showed a significantly lower risk of death in sevelamer than in calcium acetate patients (HR, 0.94; 95% CI, 0.91-0.98). Mortality results from additional analyses including only patients with low-income subsidy status were consistent with results from analyses including patients with and without low-income subsidy status. There were no significant differences between the sevelamer and calcium acetate groups for all-cause and cardiovascular-related first hospitalization, multiple hospitalizations, and hospital days. Limitations: Results may not be applicable to younger patients; information about laboratory data and over-the-counter calcium-containing binders was lacking. Conclusions: Relative to treatment with calcium acetate, treatment with sevelamer was associated with similar or slightly lower risk of death and similar risk of hospitalization in elderly incident hemodialysis patients.