Ferric citrate, an oral phosphate binder, may eliminate the need for intravenous (IV) iron in dialysis patients, researchers reported at the National Kidney Foundation’s 2014 Spring Clinical Meetings in Las Vegas.
Mohammed Sika, MD, of Vanderbilt University in Nashville, Tenn., and colleagues analyzed data from 281 patients who took oral ferric citrate to control phosphorus.
These patients had participated in a 52-week randomized clinical trial in which they were compared with patients (active controls) who took either calcium acetate and/or sevelamer carbonate. This trial demonstrated that ferric citrate effectively bound phosphate, increased iron stores, and decreased the use of IV iron and erythropoiesis stimulating agents.
In the study, IV iron use was allowed if serum ferritin levels were below 1,000 ng/mL and transferrin saturation (TSAT) was below 30%. In the last 6 months of the study, 58% of the ferric citrate recipients and 24% of the active controls received no IV iron.
Of the 281 patients, 207 received IV iron and 74 did not over 52 weeks. In the 74 no-IV-iron patients, iron absorbed from ferric citrate increased iron stores and sustained hemoglobin levels. At 52 weeks, the IV-iron and no-IV-iron groups showed no statistically significant differences in ferritin levels (911 and 863 ng/mL, respectively), iron stores (85 and 97 μg/dL), transferrin saturation (38% and 43%), and hemoglobin levels (11.3 and 11.7 g/dL).