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Kidney Week

Abstract: TH-PO148

Association Between Sevelamer Use and Risk of Gastrointestinal Bleeding in Patients with Kidney Failure

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Le, Dustin, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
  • Coresh, Josef, Johns Hopkins University Welch Center for Prevention Epidemiology and Clinical Research, Baltimore, Maryland, United States
  • Shin, Jung-Im, Johns Hopkins University Welch Center for Prevention Epidemiology and Clinical Research, Baltimore, Maryland, United States
Background

Phosphate binders are used to manage hyperphosphatemia in patients with kidney failure requiring replacement therapy. There have been multiple case reports postulating an association between sevelamer use and risk of gastrointestinal bleeding (GIB).

Methods

Using the US Renal Data System and Medicare Parts A, B, and D claims data from 2015 to 2019, we compared the risk of incident GIB hospitalization and death between sevelamer initiation and non-sevelamer phosphate binder initiation among patients on incident hemodialysis (new user, active comparator). We fit Cox regression models with inverse probability of treatment weights to estimate the adjusted hazard ratios (HR) and repeated across relevant subgroups.

Results

We identified 19,939 sevelamer and 19,166 non-sevelamer containing phosphate binder users (mean age 69 years, 52% females, 70% White, 24% Black, and mean dialysis vintage 8.2 months). There were 5,904 GIB hospitalizations and 12,591 deaths after an average of 1.8 years of follow-up. Compared with initiation of non-sevelamer binders, sevelamer was not associated with an increased risk of GIB hospitalization (HR 1.02, 95% CI 0.97 – 1.07) or all-cause mortality (HR 1.01 95% CI 0.98 – 1.05). Findings were similar across key subgroups, including those defined by diabetes, smoking, anticoagulation, sodium polystyrene, and cholestyramine status.

Conclusion

The initiation of sevelamer versus non-sevelamer containing phosphate binders was not associated with an increased risk of GIB hospitalization in patients on hemodialysis.

a GIB and location (Upper, Lower, & NOS) was defined by ICD hospitalization codes in any billing position
b GIB with Procedure was defined by ICD/CPT code for endoscopy within 7 days of hospitalization
Abbreviations: IPTW, inverse probability of treatment-weighting; HR, hazard ratio; NOS, Not otherwise specified; ICD, International Classification of Disease; CPT, Current Procedural Terminology