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Kidney Week

Abstract: TH-PO1044

Association between Use of Phosphate-Binders and the Risk of Infection-Related Mortality in Hemodialysis Patients: The Q-Cohort Study

Session Information

Category: Mineral Disease

  • 1201 Mineral Disease: Ca/Mg/PO4


  • Yamada, Shunsuke, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Hirakata, Hideki N., Fukuoka Renal Clinic, Fukuoka, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Tsuruya, Kazuhiko, Kyushu University, Fukuoka, Japan

Use of phosphate (P)-binders enables hemodialysis patients to take more protein, stay in a better nutritional status, and maintain serum P level in a recommended range. By contrast, dietary protein restriction often leads to protein-energy-malnutrition, which is closely related to the increased risk of infection-related deaths. However, it still remains unknown whether the risk of infection-related deaths is decreased in patients with P-binders compared with those without P-binders.


The present study was a prospective multicenter observational study consisting of 2926 hemodialysis patients registered to the Q-Cohort Study. The main exposure was use of P-binders and the main outcome was infection-related deaths. Patients’ information was collected only at baseline. Propensity score (PS) for P-binder use was created by multivariable logistic regression analysis. Multivariable-adjusted Cox proportional hazards models with or without PS-based approaches were used to estimate the risk of infection-related mortality.


During the 3.9 years of median follow-up period, 106 patients died of infection. Patients with P-binders showed a higher body mass index and normalized protein catabolic rate and higher serum levels of creatinine and albumin compared with those without P-binders. Even after adjustment for confounding factors including serum levels of P, albumin, and creatinine, protein catabolic rate, and body mass index, the incidence of infection-relate deaths was significantly lower in patients with P-binders than those without P-binders; hazard ratio [95% confidence interval] for infection-related deaths was 0.63 [0.40–0.99]. The associations remained significant even after applying four different propensity score (PS) based adjustments; PS matching, PS stratification, PS covariate adjustment, and inverse probability weighting treatment.


Our results suggest that use of P-binders was significantly associated with a lower incidence of infection-related deaths in hemodialysis patients, even after accounting the nutritional factors and confounding by indication. Further studies are necessary to determine why P-binder users have the advantage of having a lower risk of infection-related deaths in hemodialysis patients.