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Abstract: TH-PO139

Decision Tree Model Simulating the Burden of Hyperphosphatemia in US Adult Patients with ESKD on Dialysis

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical


  • Balabbigari, Sandeepkumar, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States
  • Gargano, Michael, Genesis Research LLC, Hoboken, New Jersey, United States
  • Benjumea, Darrin W., Genesis Research LLC, Hoboken, New Jersey, United States
  • Doan, Quan, Genesis Research LLC, Hoboken, New Jersey, United States
  • Foote, Bryce, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States

Hyperphosphatemia is a common complication in patients with end-stage kidney disease (ESKD) on dialysis. It can lead to vascular calcification, secondary hyperparathyroidism, increased risk for fractures, and other poor health outcomes. It is important to understand the extent of serum phosphate control benefit in this population.


A decision tree model was built to simulate the population-level effect of reducing serum phosphate levels in US adult patients with ESKD on in-center hemodialysis (n=480,516) over a 5-year time horizon. Patients were assigned an initial serum phosphate level derived from the US Renal Data System’s 2022 Annual Data Report, after which a reduction of 2.0 mg/dL was applied. Changes in hospitalization (all-cause, cardiovascular, and fracture), parathyroidectomies, mortality, and healthcare costs were calculated by the model based on published literature and Medicare cost data. The model does not specify how patients’ serum phosphate levels are reduced; thus, direct drug costs are not assessed.


The greatest benefit observed with modeled serum phosphate reduction is reduced mortality, with 16,565 fewer deaths occurring over the 5-year period in the simulated population compared with a population that maintained the initial serum phosphate level. There were 46,308 additional all-cause hospitalizations in the simulated population over the same time period, which comprised the majority of an additional $165.9M in Medicare costs. Key limitations of the model are that simulated serum phosphate levels did not fluctuate as they would in the real world, and that the data were derived from older retrospective studies that may not represent the present-day ESKD population.


Simulated reduction of serum phosphate levels in patients with ESKD on dialysis decreased mortality. This pronounced effect in mortality leads to an increase in all-cause hospitalization, resulting in additional Medicare costs. However, serum phosphate control is only one component of managing patients with ESKD on dialysis; there are numerous contending comorbidities and extenuating factors. These results highlight the need to continue exploring how management of patients with ESKD can provide the best patient outcomes.


  • Commercial Support – Akebia Therapeutics, Inc.