SP638NON-CALCIUM BASED PHOSPHATE BINDERS CONFER SURVIVAL BENEFIT INDEPENDENT OF PHOSPHATE REDUCTION
Bibliographic record
Abstract
Introduction and Aims: Phosphate binder therapy is an area of debate in the management of dialysis patients. It is unclear whether phosphate reduction or efficacy of phosphate binders is related to survival. An observational cohort study was conducted to analyse this relationship. Methods: Of 3381 prevalent dialysis patients within British Columbia, Canada between 2005 to 2008, patients prescribed conventional phosphate binders (CPB) (n = 420) were compared with patients (n = 420) initiated on non-calcium based phosphate binders (NCBPB) - sevelamer or lanthanum - matched by propensity score. Phosphate (Pi), calcium (Ca) and parathyroid hormone (PTH) trend over the first 12 months of therapy was determined by the gradient of a line of best fit. The relationship between trend in phosphate, therapy type and survival was analysed up to 5 years from initiation of therapy using a piece-wise Fine and Gray competing risk approach. Results: The interaction between Pi reduction and therapy type on survival was not statistically significant (p-values>0.56). Pi reduction was associated with increased probability for death in the first 12 months (p-value=0.02): hazard ratios (HR) for reduction gradient ≥0.28 and reduction 0.06 to 0.28 were 1.91 and 1.98, respectively, compared to reduction gradient <0.06. Pi reduction had no effect on survival after one year (Figure 1). NCBPB patients had a lesser reduction in phosphate (annual reduction = 0.10 [95% CI: 0.05, 0.16]) than patients on CPB (annual reduction= 0.20 [95% CI: 0.14, 0.25]) but had a reduced HR for death of 0.72 (95% CI: 0.52, 0.99) occurring 24 months after initiation of therapy (Figure 2). Transplantation rates were similar in both cohorts (10.48% (CPB) versus 12.38% (NCBPB) after 5 years) and there was no difference in the probability of transplant with respect to phosphate trend or therapy type (Figs 1 and 2).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".