Abstract: TH-PO1109
Comparison of Calcium-Containing Phosphate Binders vs. Noncalcium-Containing Phosphate Binders on Cardiovascular Outcomes: A Retrospective Cohort Study
Session Information
- CKD: Therapies, Innovations, and Insights
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Subedi, Bal K., Jefferson Einstein Montgomery Hospital, East Norriton, Pennsylvania, United States
- Upadhyay, Anuja, Jefferson Einstein Montgomery Hospital, East Norriton, Pennsylvania, United States
- Gautam, Naveen, Gulmi Durbar General Hospital, Kathmandu, Nepal
- Ojeda, Stephen Joshua A, Jefferson Einstein Montgomery Hospital, East Norriton, Pennsylvania, United States
- George, Daniel, Jefferson Einstein Montgomery Hospital, East Norriton, Pennsylvania, United States
Background
Phosphate binders are key in managing hyperphosphatemia in chronic kidney disease (CKD). However, the long-term effects of calcium-containing phosphate binders (CPB) versus non-calcium phosphate binders (non-CPB) on cardiovascular and renal outcomes remain uncertain.
Methods
A retrospective cohort study using TrinetX database, which includes electronic health records from 69 US healthcare organizations was conducted. Adults (≥ 18 years) with CKD stage 3 and 4 were identified via ICD-10 codes. Two cohorts were created: one receiving CPB and those on non-CPB. The index event was first record of CKD diagnosis and related medications. Propensity score matching was done based on demographics, comorbidities (e.g., diabetes, hypertension, tobacco use, obesity), and medications.
Outcomes over 5 years included mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure, arrhythmia, stroke, end stage renal disease (ESRD), kidney transplantation, calcium and phosphate disorders, calciphylaxis, osteoporosis, and depression. Risk ratios were calculated.
Results
We analyzed 52,613 CKD stage 3 and 4 patients on non-CPB and 85,148 on CPB. Before matching propensity score, non-CPB group had slightly younger patients (74.1+/- 13.6 vs 76.1 +/- 13.4) but had more comorbidities. After matching, 50,464 patients from each group were included.
Non-CPB users had significantly higher risk of mortality, MACE (15.0% vs 13.2%, RR 1.14), NSTEMI (8.7% vs 6.9%, RR 1.25), STEMI (2.0% vs 1.8%, RR 1.13) heart failure (30.3% vs 27.3, RR 1.11%), stroke (7.3% vs 6.6%, RR 1.10), and ESRD (16.9% vs 15.6%, RR 1.08).
CPB users had higher rates of hypocalcemia (7.2% vs 4.4%, RR 0.605), osteoporosis (7.4% vs 4.5%, RR 0.609), fractures (1.5% vs 0.9%, RR 0.593), vitamin D deficiency (18.8% vs 16.9%, RR 0.899), and hypercalcemia (5.2% vs 4.5% RR 0.863).
There were no significant differences in depression, sudden cardiac death, hyperphosphatemia, or calciphylaxis.
Conclusion
In CKD stage 3 and 4, CPB was associated with lower mortality, cardiovascular and renal complications compared to non-CPB, though with higher risk of calcium-related metabolic disturbances. These findings warrant further studies to clarify causal relations and develop guidelines to personalize binder selection.