Association of Sevelamer Initiation with Gastrointestinal Bleeding Hospitalization in Individuals Requiring Hemodialysis.
Am J Nephrol
; 55(4): 450-462, 2024.
Article
in En
| MEDLINE
| ID: mdl-38555633
ABSTRACT
INTRODUCTION:
Case reports have suggested a causative role between sevelamer use and subsequent gastrointestinal bleeding (GIB), but no large observational studies have evaluated this association.METHODS:
Using the United States Renal Data System database from 2015 to 2019, we examined the association between initiation of sevelamer (vs. non-sevelamer containing phosphate binders) and GIB hospitalization as well as all-cause mortality among individuals on hemodialysis. We emulated a target trial using Cox regression models and inverse probability of treatment weights to estimate the adjusted hazard ratios (HR) across outcomes and subgroups.RESULTS:
Among 21,354 new users of phosphate binders (11,276 sevelamer and 10,078 non-sevelamer) with baseline lab data (calcium, phosphorus, hemoglobin, and albumin), there were 2,811 GIB hospitalizations and 5,920 deaths after a median follow-up of 1.3 years. Compared with the initiation of non-sevelamer binders, sevelamer was not associated with an increased risk of GIB hospitalization (89 vs. 90 events per 1,000 person-years; IPTW-HR 0.98, 95% CI 0.91-1.06) or all-cause mortality (220 vs. 224 events per 1,000 person-years; IPTW-HR 0.98, 95% CI 0.93-1.03). Subgroup analyses (such as diabetes and anti-coagulation use) were generally consistent, and there was no association between sevelamer dose and GIB hospitalization.CONCLUSION:
Among patients requiring hemodialysis, sevelamer (vs. non-sevelamer) containing phosphate binders was not associated with increased risk of GIB hospitalization.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Chelating Agents
/
Renal Dialysis
/
Sevelamer
/
Gastrointestinal Hemorrhage
/
Hospitalization
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Am J Nephrol
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos