Phosphate binder pill burden and cardiovascular events in patients undergoing hemodialysis
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Updated: May 24, 2025

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Published on: June 2, 2022
Kiryu Yoshida1, Tomohiro Saito2, Tadashi Kato2
1Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Background:
Phosphate binders (PBs) are commonly prescribed to reduce serum phosphate levels. This study examined the association between the PB pill burden and cardiovascular events in hemodialysis patients.
Methods:
This retrospective cohort study included 395 patients undergoing hemodialysis between August 2018 and November 2023 at a single facility in Japan. Statistical analyses were conducted using baseline, time-averaged, and time-dependent Cox proportional hazard models.
Results:
Of the 395 included patients, cardiovascular events occurred in 121 patients (30.6%). The patients were categorized into tertiles based on their daily PB pill intake: T1 (<4 pills/day), T2 (4-8 pills/day), and T3 (≥9 pills/day). T3 was associated with increased cardiovascular risk (vs. T1 hazard ratio [HR] = 1.51, p = 0.064; vs. T2 HR = 2.06, p = 0.005). Similar results were obtained for the time-averaged and time-dependent models.
Conclusion:
A high PB pill burden (≥9/day) is associated with increased cardiovascular risk in patients undergoing hemodialysis.
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