Gaps exist in phosphate binder use among patients receiving dialysis, investigators reported at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts.

Among 233,235 Medicare fee-for-service beneficiaries receiving dialysis in 2019, 146,897 (63.0%) filled a prescription for a phosphate binder. In descending order, the most common phosphate binders used were sevelamer, (54.4%), calcium acetate (30.4%), ferric citrate (6.4%), sucroferric oxyhydroxide (5.7%), and lanthanum carbonate (2.0%).

Average persistence of phosphate binder use for 90 or more days was 87.2% across all binders, corresponding author Todd Berner, of Akebia Therapeutics, Inc., in Cambridge, Massachusetts, and colleagues reported. Nearly 13% of patients, however, discontinue phosphate binder therapy each year. Sevelamer and calcium acetate users persisted less often than ferric citrate, sucroferric oxyhydroxide, and lanthanum carbonate users.

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Adherence to a phosphate binder (measured as the proportion of days covered by the medication) was 66.0%. Lanthanum carbonate users had the lowest adherence and sevelamer users the highest.

The vast majority of patients received in-center hemodialysis, the investigators reported, but 10.1% and 11.0% of lanthanum carbonate and ferric citrate users, respectively, received home peritoneal dialysis. More patients taking ferric citrate (88.7%) and sucroferric oxyhydroxide (87.5%) were eligible for a low-income drug subsidy.

“Further studies are needed to determine the reasons for varied utilization across different phosphate binders,” the investigators concluded. “These studies could identify opportunities for better control of phosphate levels among patients with [chronic kidney disease].”

Disclosure: This research was supported by Akebia Therapeutics. Please see the original reference for a full list of disclosures.


Ferro C, Dieguez G, Metz S, et al. Real-world adherence and persistence on phosphate binders among dialysis-dependent patients with chronic kidney disease. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022. Poster 190.