Acid-Suppressive Agent Use and Phosphate Binder Patterns in Patients Undergoing Hemodialysis: Results from the MBD-NEXT

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Acid-Suppressive Agent Use and Phosphate Binder Patterns in Patients Undergoing Hemodialysis: Results from the MBD-NEXT

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Co-author 1

Hirotaka Komaba hkomaba@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan *

Co-author 2

Sayaka Shimizu shimizu@pedal.or.jp Patient Driven Academic League (PeDAL) Department of Research Tokyo Japan - Kyoto University Section of Clinical Epidemiology, Department of Community Medicine Kyoto Japan

Co-author 3

Naohiko Fujii nfujii-npr@umin.net Hyogo Prefectural Nishinomiya Hospital Department of Nephrology Nishinomiya Japan -

Co-author 4

Takayuki Hamano hamatea@med.nagoya-cu.ac.jp Nagoya City University Graduate School of Medical Sciences Department of Nephrology Nagoya Japan -

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Introduction

Acid-suppressive agents, including proton pump inhibitors and histamine-2 receptor antagonists, can reduce the phosphate-binding efficacy of acid-dependent phosphate binders such as calcium carbonate and lanthanum carbonate. However, their real-world impact on the use and dosing of phosphate binders in hemodialysis patients remains unclear.

Methods

We analyzed data from the Mineral and Bone Disorder-New EXecute Trial (MBD-NEXT). Among 6,027 participants as of June 2021, 5,172 patients prescribed any phosphate binder were included. Patients were classified by binder type (acid-dependent: calcium carbonate or lanthanum carbonate; acid-independent: all others) and by the use of acid-suppressive agents. The total daily dose of phosphate binders prescribed was expressed in sevelamer-equivalent doses. A multivariable linear regression model with an interaction term between acid-suppressive therapy and binder type was used to estimate the effect of acid-suppression therapy on prescribed binder doses.

Results

Overall, 62.1% of patients received acid-suppressive therapy, and the median daily binder dose was 4.2 g/day (interquartile range, 2.1 to 6.3). The prevalence of acid-dependent binder use was 84.1% among acid-suppressive agent users and 87.0% among non-users. In multivariable analyses, the interaction term was significant: acid-suppressive therapy was associated with an 8.9% higher binder dose (95% CI: 4.3 to 13.4%) among acid-dependent binder users, with no significant difference among acid-independent binder users (−3.9%; 95% CI: −13.6 to 5.8%).

Conclusion

A substantial proportion of hemodialysis patients receive acid-dependent phosphate binders despite concomitant acid-suppressive therapy, which is associated with higher prescribed binder doses. The potential impact of acid-suppressive therapy should be considered to optimize phosphate binder use in clinical practice.

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