Long-term efficacy and safety of iron-based phosphate binders, ferric citrate hydrate and sucroferric oxyhydroxide, in hemodialysis patients

• Published in: International urology and nephrology 2022-04, Vol.54 (4), p.861-872
• Main Authors: Yoshida, Tadashi, Morimoto, Kohkichi, Kaburagi, Noriko, Fujino, Teppei, Takemitsu, Tomoko Yamashita, Yamashita, Norimasa, Oya, Mototsugu
• Format: Article
• Language: English
• Subjects: Citric acid; Drug Combinations; End-stage renal disease; Erythropoiesis; Ferric citrate; Ferric Compounds; Ferritin; Hemodialysis; Hemoglobin; Humans; Hyperphosphatemia; Hyperphosphatemia - drug therapy; Hyperphosphatemia - etiology; Intravenous administration; Iron; Iron - metabolism; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Nephrology - Original Paper; Parathyroid; Parathyroid hormone; Patients; Phosphate; Phosphates; Renal Dialysis - adverse effects; Retrospective Studies; Serum levels; Sucrose; Transferrin; Urology
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-021-02952-1

Purpose Iron-based phosphate binders, including ferric citrate hydrate (FCH) and sucroferric oxyhydroxide (SFOH), have been used for the treatment of hyperphosphatemia in end-stage renal disease patients on dialysis. However, the long-term efficacy and safety of these agents have not yet been clearly elucidated. Methods Laboratory data of 56 hemodialysis patients who had been prescribed either FCH ( n  = 33) or SFOH ( n  = 23) were retrospectively examined. Results We showed that both FCH and SFOH significantly and consistently decreased serum phosphate concentrations in the patients undergoing maintenance hemodialysis during the 36-month observation period. Serum levels of calcium, intact parathyroid hormone, as well as hemoglobin levels were unaltered. No overshoot of parameters of iron metabolism, such as transferrin saturation and serum ferritin levels, was observed, and serum ferritin level remained under 300 ng/mL in most patients. A trend towards decrease in the doses of erythropoiesis-stimulating agents used and frequency of intravenous iron use was observed in both treatment groups. No severe adverse drug reactions were observed in either the patients receiving FCH or SFOH. Conclusion The results of the present study suggest that the iron-based phosphate binders, FCH and SFOH, decrease serum phosphate concentrations consistently and are safe to use over the long-term in maintenance hemodialysis patients.