Calcimimetics reduce mortality in elderly dialysis patients with protein-energy wasting and inflammation

Calcimimetics reduce mortality in older patients on dialysis. Because elderly patients are prone to protein-energy wasting (PEW) and inflammation, we investigated whether this effect is independent of these conditions. This retrospective study used propensity score matching to compare 2-year all-cause mortality between calcimimetic users and non-users. Patients were stratified into those without PEW and inflammation (Group 1, n = 240) and those with PEW and/or inflammation (Group 2, n = 498). Survival was assessed using Kaplan–Meier survival curves, censored for calcimimetic use and other covariates. In Group 2, mortality was significantly lower in calcimimetic users than in non-users after matching (hazard ratio [HR] 0.221, 95% confidence interval [CI] 0.073–0.670, P = 0.003, log-rank test), but not in Group 1. The significant difference in Group 2 was no longer observed after Cox proportional hazards regression adjusted for covariates that remained imbalanced following matching (adjusted HR, 0.272, 95% CI 0.073–1.006, P = 0.051). In Group 2, age-stratified analysis (median 69 years) showed significantly lower mortality in calcimimetic users among older patients (HR, 0.206, 95% CI, 0.058–0.728, P = 0.014), but not younger patients. These findings suggest that calcimimetics reduce mortality in elderly patients with PEW and/or inflammation, but not in those without these conditions.