The iron-based phosphate binder sucroferric oxyhydroxide is as effective as the calcium-free binder sevelamer in reducing serum phosphorus levels in dialysis patients, but it is associated with fewer side effects and lower pill burden, according to researchers.

Dengpiao Xie and colleagues from Chengdu University of Traditional Chinese Medicine, Chengdu, in Sichuan, China, conducted a systematic review of 4 randomized controlled trials published 2013 to 2017 comparing sucroferric oxyhydroxide (PA21) and sevelamer. Data from 2027 hemodialysis and peritoneal dialysis patients treated for 6 to 28 weeks were pooled for analysis. 

The team found no significant differences in serum phosphorus or calcium levels between groups, according to findings published in International Urology and Nephrology. Sucroferric oxyhydroxide recipients experienced fewer overall adverse events and fewer gastrointestinal side effects, including diarrhea, constipation, vomiting, nausea and abdominal discomfort. They also required 8 fewer daily pills on average.

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“PA21 could be another valuable choice for dialysis patients with hyperphosphatemia when the patients are unable to tolerate sevelamer,” Xie and colleagues remarked. Sevelamer use is associated with gastrointestinal mucosal ulcers, inflammation, and necrosis, according to background information.

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Xie D, Ye N, and Li M. A systematic review on the efficacy and safety of PA21 versus sevelamer in dialysis patients.  Intl Urol Nephrol. doi: 10.1007/s11255-017-1774-9