Association between sevelamer use and outcomes in acute kidney injury with hyperphosphataemia: evidence from the MIMIC-IV.

Background: Hyperphosphataemia is consistently linked to adverse clinical outcomes in Acute Kidney Injury (AKI). Sevelamer, a non-calcium phosphate binder widely used in chronic kidney disease (CKD), has not been adequately evaluated for efficacy in AKI. Methods: We performed a retrospective cohort analysis in the MIMIC- IV database. The association between sevelamer exposure and 28- day all-cause mortality was estimated using multivariable Cox models and propensity score matching (PSM). Results: After adjustment for baseline excoriates, sevelamer use was associated with a 48% relative lower in 28- day mortality (adjusted HR 0.52; 95% CI 0.39-0.68; P < 0.001). Findings were consistent across propensity-score methods. Overlap-weighted Kaplan-Meier curves showed higher cumulative survival in the sevelamer group (P < 0.001). In two-part hurdle model analyses, sevelamer use was associated with significantly higher odds of having any ventilator-free days (OR = 2.53, Conclusion: In this ICU cohort of AKI patients with Hyperphosphataemia, sevelamer use was associated with substantially lower 28- day mortality. Moreover, sevelamer administration was associated with a clinically significant increase in the likelihood of liberation from mechanical ventilation, ICU discharge, and discontinuation of vasopressor support. These findings broaden the clinical indications of sevelamer and propose a novel therapeutic strategy for the management of AKI-associated hyperphosphatemia.