Chronic kidney disease, hypertension and silent brain infarction.

With respect to the DCOR study, its duration was limited to 3 years. Note that in the follow-up study of the RIND population [3], no survival difference was apparent at this time point, but that it rather took >5 years to show a benefit of avoiding calcium-containing phosphate binders in this admittedly small study. Furthermore, a 49% dropout in DCOR by the end of the study renders any interpretation of that trial difficult. Finally, my central argument was—and still is—that in CARE-2, as opposed to TTG, the prevalences of diabetic nephropathy and of smokers, both established and very potent risk factors for cardiovascular calcifications, were considerably higher. They may have driven the faster progress of calcifications in CARE-2 and both are unlikely to be affected by the choice of phosphate binders. I absolutely agree with Drs Qunibi et al., that there is not, and likely never will be, any formal evidence to support this notion. It just seems pretty likely to me.