Abstract: FR-PO0316
Morbidity and Mortality Risks Associated with Cumulative Hyperphosphatemia in a Contemporary Cohort of US Patients on Dialysis
Session Information
- CKD-MBD: Mechanistic Insights and Management
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Scialla, Julia J., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Jaar, Bernard G., Johns Hopkins School of Medicine, Baltimore, Maryland, United States
- Ji, Nan, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Scott, Luisa L., Ardelyx, Inc., Waltham, Massachusetts, United States
Background
Previous work shows associations between uncontrolled hyperphosphatemia (HP) and worse clinical outcomes. We analyzed associations between cumulative HP and clinical outcomes in contemporary hemodialysis (HD) and peritoneal dialysis (PD) cohorts during an era with more permissive HP management strategies.
Methods
We used 2013-2023 United States Renal Data System data on adult dialysis patients (pts) (PD and HD) who may be using phosphate binders (PBs). Cumulative HP was assessed over the first qualifying 6-month period after 01 Jan 2013 (≥90 days after dialysis initiation; with ≥4 serum phosphate [P] measurements). Cumulative HP, defined as a 6-month serum P area under the curve (AUC) >6.5 mg/dL, was estimated using monthly measures. Subsequent all-cause and cardiovascular (CV) hospitalization and mortality were assessed using claims and registry reporting. Adjusted associations between cumulative HP and clinical outcomes were analyzed using Cox and Poisson regression models, stratified by dialysis modality.
Results
Of 942,281 pts, 43% had cumulative HP, ~60% of whom were on PBs. Pts on PBs with cumulative HP experienced a ~13%–58% and ~33%–101% higher risk of all-cause mortality (HD and PD, respectively) relative to pts without cumulative HP. Risks for CV-related death and all-cause and CV-related hospitalizations were also higher with greater cumulative HP (Fig 1). Assuming a causal association, the attributable risks of exposure for all-cause mortality and hospitalizations were 7.3% and 4.1%, respectively, in HD pts and 13.5% and 5.7% in PD pts.
Conclusion
In an era of increasing serum P in the dialysis population, the relative and attributable risks associated with greater cumulative HP are high and warrant increased attention.
Funding
- Commercial Support – Ardelyx, Inc.