Phosphate Binder May Reduce the Number of Hospitalization Days

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ORLANDO, Fla.—Using sevelamer instead of calcium-based binders (CBBs) to treat hyperphosphatemia in dialysis patients can significantly decrease the number of days of hospitalization, a new analysis shows.

The finding is based on a model simulating the survival and days spent hospitalized for a hypothetical cohort of patients receiving dialysis in outpatient dialysis centers.

Canadian researchers assumed each patient received dialysis three times a week and that when a patient was hospitalized, dialysis care for that patient ceased to occur in the in-center clinical and was transitioned to the hospital. The analysis considered a dialysis clinic of 75 patients with characteristics similar those of patients in the Dialysis Clinical Outcomes Revisited (DCOR) study (mean age 60 years, 54.4% male, and 50.2% diabetic).

DCOR showed that hyperphosphatemia treatment with sevelamer offers a significant reduction in hospitalizations relative to treatment with CBBs.

The researchers assumed a one-year mortality rate of 14.5% and that the number of days of hospitalization per patient per year was 12.3 for sevelamer and 13.9 for CBBs, based on data from previous studies (Kidney Int. 2007;72:1130-1137; Am J Kidney Dis. 2008;51:445-454).

Using sevelamer instead of CBBs avoided 119 days of hospitalization and maintained 51 in-center dialysis sessions within one year of treatment, the researchers reported here at the National Kidney Foundation's 2010 Spring Clinical Meetings.

If these findings are extended to the entire U.S. dialysis population of 367,604 patients, use of sevelamer instead of CBBs would translate into 581,163 hospitalization days avoided each year and 249,070 in-center dialysis sessions maintained per year, the researchers reported. “Use of sevelamer versus CBBs may contribute to improved patient outcomes via undisrupted delivery of care within the dialysis clinic,” the authors concluded.

Moreover, in the United States, use of sevelamer rather than CBBs “could result in an increased number of reimbursement payments to dialysis providers by avoiding hospitalization days and maintaining dialysis sessions within the dialysis center.”
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