The following article features coverage from the National Kidney Foundation’s 2019 Spring Clinical Meetings. Click here to read more of Renal & Urology News’ conference coverage.

Patients on hemodialysis (HD) who have serum ferritin levels exceeding 1000 mcg/dL respond poorly to intravenous iron and have increased risks for infection. According to investigators presenting at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, the oral, iron-based phosphate binder, ferric citrate, can increase iron parameters and reduce erythropoiesis-stimulating agents (ESA) use in patients with low transferrin saturations (TSAT).

Monica Rodriguez, RN, from Baylor College of Medicine in Houston, and colleagues conducted a pragmatic pilot clinical trial of 17 HD patients and reported interim results. At baseline, the mean serum ferritin level was 1179 ng/mL, mean TSAT was 23.6%, and mean ESA dose was 51.5 units per week. After 90 days of ferric citrate (at least 6 pills/d at 210 mg per 2 pills), mean TSAT increased by more than half to 36.1% whereas mean ferritin decreased by 15% to 1023 ng/mL. Patients also required less ESA. Mean ESA dose decreased by nearly half to 28.3 units/week.

The most common adverse event was diarrhea. One patient taking ferric citrate withdrew from the trial after 1 month due to constipation.

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“Ferric citrate appears to increase iron stores in ESRD patients that have high ferritin and low TSAT and appears to reduce ESA use,” Rodriguez and the team concluded.

The study was funded by Keryx Biopharmaceuticals, which manufactures Auryxia (ferric citrate).

Read more of Renal & Urology News’ coverage of NKF’s 2019 Spring Clinical Meetings by visiting the conference page.


Rodriguez M, DeLeon D, Perez J, et al. Effect of ferric citrate on ESA use in ESRD patients with elevated ferritin. Poster presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, May 8-12, 2019. Poster 189.