Phosphate binder use by patients on hemodialysis (HD) is associated with a lower risk of infection-related and all-cause mortality, new findings suggest.

In a paper published in Scientific Reports (2018;8:11387), Shunsuke Yamada, MD, PhD, of Kyushu University in Fukuoka, Japan, and colleagues reported on a study of 2926 HD patients showing that those who took phosphate binders, compared with those who did not, had a significant 37% decreased risk of infection-related death and 25% decreased risk of all-cause mortality in multivariable-adjusted models.

In 4 different propensity score-based analyses, phosphate binder use was associated a significant 37% to 44% reduced risk of infection-related death and 26% to 31% reduced risk of all-cause mortality.

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The authors explained that phosphate binder use enables HD patients to consume more protein and thereby maintain good nutritional status. Protein-energy-malnutrition increase the risk of infection-related death. Because phosphate binders can improve phosphate management with less risk of malnutrition than dietary protein restriction, “these agents are expected to allow patients to maintain a better nutritional state whilst decreasing the chance of infection, thereby reducing the risk of infection-related mortality.”

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The patients, who were part of the Q-Cohort Study, had a median follow-up period of 4 years, during which 106 died from infection and 492 died from any cause. Of the 2926 patients, 2409 used phosphate binders and 517 did not.


Yamada S, Tokumoto M, Taniguchi M, et al. Use of phosphate binders and risk of infection-related and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort Study. Sci Rep. 2018;8:11387.