Switching to Iron-Based Binder Improves Phosphorus Control
In 2 studies, roughly a third of hemodialysis patients achieved within-range serum phosphate levels after converting to sucroferric oxyhydroxide from another phosphate binder.
Switching to the iron-based phosphate binder sucroferric oxyhydroxide (SO) improves medication adherence and phosphate control in patients on hemodialysis (HD), 2 new studies suggest.
In study results published in the Journal of Renal Nutrition, an increasing proportion of 530 HD patients switched to SO during routine clinical practice achieved target serum phosphorus levels (5.5 mg/dL or less) over 1 year: from 17.7% at baseline to 24.5%, 30.5%, 36.4%, and 36.0% at Q1 through Q4, respectively, increases that were statistically significant. Pill burden decreased by around half, from 8.5 to 4.0–4.3 pills daily. The investigators, led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California, Irvine, observed improvement in black, Hispanic, and female patients as well as in white and male patients. In addition, normalized protein catabolic rate improved significantly after transition, suggesting better nutrition.
“Clinicians have an increasing armamentarium of pharmacologic options for lowering serum phosphorus levels among patients with ESRD undergoing maintenance hemodialysis. This analysis suggests that switching patients with hyperphosphatemia to SO is an effective means of achieving further phosphorus control while simultaneously reducing the pill burden experienced by patients and improving the nutritional status,” Dr Kalantar-Zadeh's team wrote.
In the second study, which was published in the International Journal of Nephrology and Renovascular Disease, the proportion of 490 patients on HD who converted to SO and achieved target range phosphorus levels increased significantly from 22% to 30% over 6 months. Pill burden decreased significantly from 10.8 to 5.5 pills daily.
In both studies, parathyroid hormone levels increased in patients for unclear reasons.
The studies were retrospective analyses of electronic health record data. Reasons for SO initiation and discontinuation were not available, which is a study limitation.
Both analyses were funded by Fresenius Medical Care, the makers of brand name sucroferric oxyhydroxide, Velphoro.
Kendrick J, Parameswaran V, Ficociello LH, et al. One-year historical cohort study of the phosphate binder sucroferric oxyhydroxide in patients on maintenance hemodialysis. J Renal Nutr; 2019; published online ahead of print.
Gray K, Ficociello LH, Hunt AE, et al. Phosphate binder pill burden, adherence, and serum phosphorus control among hemodialysis patients converting to sucroferric oxyhydroxide. Intl J Neph Renovasc Dis. 2019; published online ahead of print.