Real-World Evidence for Sevelamer vs Calcium-Containing Phosphate Binders in Long-Term Effectiveness and Safety Among Patients with Non-Dialysis CKD: The REVEAL Study

作者：Li P, Li C, Liang S, Sun X, Guo X, Xu X, Hao L, Chen X, Feng Z, Cai G · 发表于：Advances in therapy · 年份：2026 · DOI：10.1007/s12325-026-03572-w · 被引用次数：51 · 研究领域：Sevelamer、Chelating Agents、Renal Insufficiency, Chronic、Hyperphosphatemia、Humans、Retrospective Studies、Female、Male、Aged、Middle Aged、Cardiovascular Diseases、Phosphates

INTRODUCTION: Elevated serum phosphate is a major risk factor for cardiovascular events and mortality in patients with chronic kidney disease (CKD). Both calcium- and non-calcium-containing phosphate binders (CPBs and NCPBs) are effective at lowering serum phosphate in patients with non-dialysis-dependent CKD (ND-CKD). The critical knowledge gap is whether CPBs or NCPBs provide meaningful long-term benefits for patients with ND-CKD, including slowing progression to end-stage renal disease (ESRD) and reducing cardiovascular events. METHODS: This retrospective study was based on the Optum Clinformatics® administrative claims data from between 1 August 2000 and 30 November 2021. Adults with ND-CKD and hyperphosphataemia or serum phosphorus ≥ 1.78 mmol/L (≥ 5.5 mg/dL) who had received either sevelamer (a NCPB) or a CPB for ≥ 90 days underwent propensity score matching (PSM) to balance baseline characteristics. The primary endpoint was initiation of renal replacement therapy (RRT) over 3 years. Secondary composite endpoints were the incidence of major adverse cardiovascular events (MACE; myocardial infarction, stroke and all-cause death) and MACE plus (MACE, unstable angina pectoris and heart failure). RESULTS: Of 9047 patients who underwent PSM (sevelamer, n = 6644; CPBs, n = 2403), data from 4798 were analysed (2399 in each group). Over 3 years, RRT initiation had significantly lower incidence with sevelamer than CPBs (65.0% vs 70.3%; hazard ratio [HR] 0.84, 95% confidence int...