{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T13:43:58Z","timestamp":1771508638650,"version":"3.50.1"},"reference-count":54,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Valencian Society of Nephrology, the Spanish Society of Nephrology, and the Tom\u00e1s de Osma Renal Foundation"},{"name":"bbott, Hoffmann-La Roche and Boehringer Ingelheim"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4\u20135 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13\u201336 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.<\/jats:p>","DOI":"10.3390\/jcm12247631","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T05:23:22Z","timestamp":1702358602000},"page":"7631","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-6214","authenticated-orcid":false,"given":"Pablo","family":"Molina","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"},{"name":"Department of Medicine, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1767-2714","authenticated-orcid":false,"given":"Mariola D.","family":"Molina","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Universidad de Alicante, 03690 Sant Vicent del Raspeig, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan J.","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ver\u00f3nica","family":"Escudero","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Torralba","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital General Universitario, 03010 Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8363-1953","authenticated-orcid":false,"given":"Cristina","family":"Castro-Alonso","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Beltr\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n","family":"Vizca\u00edno","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"},{"name":"Department of Medicine, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercedes","family":"Gonz\u00e1lez-Moya","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"},{"name":"Department of Medicine, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Kanter","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4170-9003","authenticated-orcid":false,"given":"Asunci\u00f3n","family":"Sancho-Calabuig","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari Dr. Peset, Fundaci\u00f3n para el Fomento de la Investigaci\u00f3n Sanitaria y Biom\u00e9dica de la Comunitat Valenciana, 46017 Valencia, Spain"},{"name":"Department of Medicine, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-2273","authenticated-orcid":false,"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-9051","authenticated-orcid":false,"given":"Jos\u00e9 L.","family":"G\u00f3rriz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"Department of Nephrology, Hospital Cl\u00ednico Universitario, Fundaci\u00f3n para la Investigaci\u00f3n del Hospital Cl\u00ednico de la Comunidad Valenciana, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"ref_1","first-page":"46","article-title":"Characteristics of bone mineral metabolism in patients with stage 3\u20135 chronic kidney disease not on dialysis: Results of the OSERCE study","volume":"33","author":"Molina","year":"2013","journal-title":"Nefrologia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1038\/ki.2011.47","article-title":"Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease","volume":"79","author":"Isakova","year":"2011","journal-title":"Kidney Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1681\/ASN.2004070602","article-title":"Serum phosphate levels and mortality risk among people with chronic kidney disease","volume":"16","author":"Kestenbaum","year":"2005","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1093\/ndt\/gfm286","article-title":"High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients","volume":"22","author":"Voormolen","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"268","DOI":"10.5414\/CNP73268","article-title":"Outcomes associated with serum phosphorus level in males with non-dialysis dependent chronic kidney disease","volume":"73","author":"Kovesdy","year":"2010","journal-title":"Clin. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.2215\/CJN.00810110","article-title":"Serum phosphate and mortality in patients with chronic kidney disease","volume":"5","author":"Eddington","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s40620-020-00916-9","article-title":"Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: The PECERA study","volume":"34","author":"Molina","year":"2021","journal-title":"J. Nephrol."},{"key":"ref_8","first-page":"CD006023","article-title":"Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"8","author":"Ruospo","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1053\/j.ajkd.2020.05.025","article-title":"State-of-the-Art Management of Hyperphosphatemia in Patients with CKD: An NKF-KDOQI Controversies Perspective","volume":"77","author":"Scialla","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.ekir.2019.06.002","article-title":"Strategies for Phosphate Control in Patients with CKD","volume":"4","author":"Barreto","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2017). KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 7, 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_13","first-page":"1","article-title":"Recommendations of the Spanish Society of Nephrology for the management of mineral and bone metabolism disorders in patients with chronic kidney disease: 2021 (SEN-MM)","volume":"43","author":"Torregrosa","year":"2023","journal-title":"Nefrologia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1038\/ki.2011.490","article-title":"Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets","volume":"81","author":"Spiegel","year":"2012","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1038\/ki.2012.403","article-title":"Oral calcium carbonate affects calcium but not phosphorus balance in stage 3\u20134 chronic kidney disease","volume":"83","author":"Hill","year":"2013","journal-title":"Kidney Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"232","DOI":"10.2215\/CJN.06800615","article-title":"Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials","volume":"11","author":"Patel","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"654","DOI":"10.2215\/CJN.07450714","article-title":"Vascular calcification in patients with nondialysis CKD over 3 years","volume":"10","author":"Molina","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"642718","DOI":"10.3389\/fmed.2021.642718","article-title":"Clinical Approach to Vascular Calcification in Patients with Non-Dialysis Dependent Chronic Kidney Disease: Mineral-Bone Disorder-Related Aspects","volume":"8","author":"Bover","year":"2021","journal-title":"Front. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/S0140-6736(13)60897-1","article-title":"Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: An updated systematic review and meta-analysis","volume":"382","author":"Jamal","year":"2013","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.kint.2017.04.006","article-title":"Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: What\u2019s changed and why it matters","volume":"92","author":"Ketteler","year":"2017","journal-title":"Kidney Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1053\/j.ajkd.2017.07.019","article-title":"KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)","volume":"70","author":"Isakova","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Therneau, T.M., and Grambsch, P.M. (2000). Modeling Survival Data: Extending the Cox Model. In Statistics for Biology and Health, Springer.","DOI":"10.1007\/978-1-4757-3294-8"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1681\/ASN.2005090986","article-title":"Mortality risk stratification in chronic kidney disease: One size for all ages?","volume":"17","author":"Bertenthal","year":"2006","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1007\/s40620-023-01626-8","article-title":"Clinical factors for predicting cardiovascular risk, need for renal replacement therapy, and mortality in patients with non-dialysis-dependent stage 3\u20135 chronic kidney disease from the Salford Kidney Study","volume":"36","author":"Stoelzel","year":"2023","journal-title":"J. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5527\/wjn.v10.i4.59","article-title":"Prediction of mortality among patients with chronic kidney disease: A systematic review","volume":"10","author":"Hansrivijit","year":"2021","journal-title":"World J. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.clnu.2018.01.001","article-title":"Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients","volume":"38","author":"Jagadeswaran","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Major, R.W., Cheng, M.R.I., Grant, R.A., Shantikumar, S., Xu, G., Oozeerally, I., Brunskill, N.J., and Gray, L.J. (2018). Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192895"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1159\/000346846","article-title":"Vitamin D treatment and mortality in chronic kidney disease: A systematic review and meta-analysis","volume":"37","author":"Duranton","year":"2013","journal-title":"Am. J. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zheng, Z., Shi, H., Jia, J., Li, D., and Lin, S. (2013). Vitamin D supplementation and mortality risk in chronic kidney disease: A meta-analysis of 20 observational studies. BMC Nephrol., 14.","DOI":"10.1186\/1471-2369-14-199"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1093\/ndt\/gfs310","article-title":"Instrumental variable analysis","volume":"28","author":"Stel","year":"2013","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1053\/j.ajkd.2013.03.023","article-title":"Sevelamer versus calcium carbonate in incident hemodialysis patients: Results of an open-label 24-month randomized clinical trial","volume":"62","author":"Molony","year":"2013","journal-title":"Am. J. Kidney Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1038\/sj.ki.5002059","article-title":"Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients","volume":"71","author":"Block","year":"2007","journal-title":"Kidney Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1038\/sj.ki.5002466","article-title":"Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients","volume":"72","author":"Suki","year":"2007","journal-title":"Kidney Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1185\/03007990903399398","article-title":"Assessment of survival in a 2-year comparative study of lanthanum carbonate versus standard therapy","volume":"25","author":"Wilson","year":"2009","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2215\/CJN.03820411","article-title":"Mortality in kidney disease patients treated with phosphate binders: A randomized study","volume":"7","author":"Bellasi","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1038\/sj.ki.5002518","article-title":"The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer","volume":"72","author":"Russo","year":"2007","journal-title":"Kidney Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1681\/ASN.2012030223","article-title":"Effects of phosphate binders in moderate CKD","volume":"23","author":"Block","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1038\/ki.2013.258","article-title":"Serum phosphorus in people with chronic kidney disease: You are what you eat","volume":"84","author":"Tonelli","year":"2013","journal-title":"Kidney Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/nep.14011","article-title":"Systematic review and meta-analysis of potential pleiotropic effects of sevelamer in chronic kidney disease: Beyond phosphate control","volume":"27","author":"Basutkar","year":"2022","journal-title":"Nephrology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"257","DOI":"10.2165\/11539120-000000000-00000","article-title":"Pleiotropic effects of sevelamer beyond phosphate binding in end-stage renal disease patients: A randomized, open-label, parallel-group study","volume":"31","author":"Lin","year":"2011","journal-title":"Clin. Drug Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1046\/j.1523-1755.2002.00459.x","article-title":"Bile acid binding to sevelamer HCl","volume":"62","author":"Braunlin","year":"2002","journal-title":"Kidney Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1053\/jarr.2003.50016","article-title":"Meta-analysis of the effect of sevelamer on phosphorus, calcium, PTH, and serum lipids in dialysis patients","volume":"10","author":"Burke","year":"2003","journal-title":"Adv. Ren. Replace. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1111\/dom.13272","article-title":"Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer","volume":"20","author":"Mikkelsen","year":"2018","journal-title":"Diabetes Obes. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1053\/j.ajkd.2019.01.029","article-title":"Effects of Sevelamer Carbonate in Patients with CKD and Proteinuria: The ANSWER Randomized Trial","volume":"74","author":"Ruggiero","year":"2019","journal-title":"Am. J. Kidney Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"765","DOI":"10.14740\/jocmr1803e","article-title":"Effects of Sevelamer Hydrochloride on Uremic Toxins Serum Indoxyl Sulfate and P-Cresyl Sulfate in Hemodialysis Patients","volume":"9","author":"Lin","year":"2017","journal-title":"J. Clin. Med. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1046\/j.1523-1755.2002.00434.x","article-title":"Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients","volume":"62","author":"Chertow","year":"2002","journal-title":"Kidney Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1111\/j.1523-1755.2005.00600.x","article-title":"Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis","volume":"68","author":"Block","year":"2005","journal-title":"Kidney Int."},{"key":"ref_49","first-page":"714205","article-title":"The Influence of Sevelamer Hydrochloride and Calcium Carbonate on Markers of Inflammation and Oxidative Stress in Hemodialysis at Six Months of Follow-Up","volume":"8","year":"2021","journal-title":"Front. Med. (Lausanne)"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1080\/14656566.2016.1182155","article-title":"Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): From treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification","volume":"17","author":"Bover","year":"2016","journal-title":"Expert. Opin. Pharmacother."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1001\/jama.2016.16435","article-title":"Confounding by Indication in Clinical Research","volume":"316","author":"Kyriacou","year":"2016","journal-title":"JAMA"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1157\/13071942","article-title":"Estudios observacionales para evaluar la efectividad cl\u00ednica de los medicamentos. Uso de listas-gu\u00eda para su dise\u00f1o, an\u00e1lisis e interpretaci\u00f3n [Observationalstudiestoevaluatetheclinicaleffectivenessofdrugs. Use of guide lists for their design, analysis, and interpretation]","volume":"35","year":"2005","journal-title":"Aten. Primaria"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1093\/ndt\/gfac236","article-title":"Treatment of secondary hyperparathyroidism in non-dialysis CKD: An appraisal 2022s","volume":"38","author":"Ketteler","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1056\/NEJM200006223422511","article-title":"Randomized trials or observational tribulations?","volume":"342","author":"Pocock","year":"2000","journal-title":"N. Engl. J. 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