Publication Spotlight: Dr. Le
Interview with Dustin Le, MD, Postdoctoral Fellow (MHS), Johns Hopkins Bloomberg School of Public Health, author of Association of Sevelamer Initiation with Gastrointestinal Bleeding Hospitalization in Individuals Requiring Hemodialysis.
What question did your study aim to answer?
We wanted to assess the risk of gastrointestinal bleeding (GIB) after starting sevelamer containing phosphate binders.
What inspired you to conduct this study?
During my first year of nephrology fellowship, we had a patient undergo endoscopic evaluation for GIB, and there were sevelamer crystals found on the tissue biopsy. This has been seen worldwide raising concern for a causative role, but no epidemiologic studies have evaluated this association. Given that GIB and sevelamer prescription are common among patients requiring dialysis, we felt this was an important topic of interest for patients and healthcare providers.
Which USRDS datasets did you use to conduct your study?
We used a variety of files including the medical evidence form, hospital and institutional claims, physician/supplier claims, and prescription drug claims.
Using plain language, please summarize your study conclusions in two or three points.
- Among patients on in-center hemodialysis who start a phosphate binder, GIB-associated hospitalization is common with about 1 in 3 patients eventually having a GIB, and sevelamer initiation was not associated with a higher risk of GIB-associated hospitalization.
- Taken together, our results suggest initiatives to decrease GIB are needed, but decreasing sevelamer use is unlikely to decrease this risk.
Please share a specific insight about working with USRDS data that you learned during the completion of this study.
The USRDS is a comprehensive and freely provided resource to kidney researchers. Given that patients requiring dialysis are commonly excluded from clinical trials, the USRDS is the principal tool to develop evidence-based care in this vulnerable population. For example, what is the risk of sevelamer containing phosphate binders and GIB?