Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan.
Department of Medicine, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan.
Clin Exp Nephrol. 2023 Nov;27(11):961-971. doi: 10.1007/s10157-023-02388-0. Epub 2023 Aug 14.
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.
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.
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.
Dialysis patients prescribed a higher rate of PB pills to all medications exhibited a lower mortality risk, possibly due to their better nutritional status.
透析患者常服用多种口服药物，导致药物负担沉重。其中，磷结合剂（PBs）在每日药物负担（DPB）中占很大比例。DPB 与死亡风险之间的关系尚不清楚，我们假设这种关系可能受 PBs 占所有药物的比例影响。
我们将 DPB 分为来源于 PBs 和非 PBs 药物的部分，并使用基线模型分析了 513 名慢性血液透析患者在 7 年期间 DPB 与死亡风险之间的关系。
所有药物的 DPB 中位数（四分位距）为 15.8（11.2-21.0）片/天/患者，基线时 PBs 药物与所有药物的比值中位数为 29.3（13.7-45.9）%。在中位观察期 5.2 年内，有 161 名患者（31.4%）死亡。Kaplan-Meier 分析显示，PB 使用组与非使用组之间全因死亡率无显著差异。然而，与最低三分位组相比，最高三分位组 PBs 来源的 DPB 具有显著的生存优势。相反，来自非 PBs 药物的 DPB 最高三分位组与较差的生存相关。因此，PB 与所有药物的比值最高三分位组与更好的生存相关。即使在 Cox 比例风险模型中调整了患者特征，这种关联仍然显著。然而，当将血清营养参数作为协变量纳入时，显著关联消失。
与所有药物相比，被处方更高比例 PBs 药物的透析患者的死亡率风险较低，这可能与其更好的营养状况有关。
