Patients on dialysis who switched from calcium-based phosphate binders to sucroferric oxyhydroxide or sevelamer for 1 year experienced significantly reduced serum fibroblast growth factor 23 (FGF-23) levels, a new study finds.

In a post hoc analysis of a phase 3 trial, Markus Ketteler, MD, of Klinikum Coburg and KfH-Dialysis Center in Coburg, Germany, and collaborators pooled results from 549 patients randomly assigned 2:1 to sucroferric oxyhydroxide (1 to 3 g daily) or sevelamer (2.4 to 14.4 g) daily for 24 weeks, followed by a 28-week extension. Two-thirds switched from a calcium-based binder. A previous analysis of the study showed that sucroferric oxyhydroxide and sevelamer similarly reduced serum phosphorus levels.

According to results published in Nephrology Dialysis Transplantation, treatment with the non-calcium binders for 1 year was associated with a significant 30% reduction in serum phosphorus. Median intact FGF-23 significantly fell by 64%.

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Intact parathyroid hormone levels initially decreased, then rebounded (patients with secondary hyperparathyroidism were excluded from the study). Serum calcium stayed relatively stable. The bone formation markers bone-specific alkaline phosphatase and osteocalcin increased.

The drop in FGF-23 could not be explained entirely by the fall in phosphorus, according to the investigators. A lack of calcium loading (from calcium-based binders) may have contributed to this decline.

These potentially beneficial changes in parameters of chronic kidney disease-mineral bone disease, notably FGF-23, might reduce risk of cardiovascular morbidity and mortality, Dr Ketteler and his colleagues stated. FGF-23 has been linked with left ventricular hypertrophy, vascular calcification, impaired immune response, inflammation, infection, and mortality.

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Ketteler M, Sprague SM, Covic AC, et al. Effects of sucroferric oxyhydroxide and sevelamer carbonate on chronic kidney disease–mineral bone disorder parameters in dialysis patients. Nephrol Dial Transplant 2018;1–8. doi: 10.1093/ndt/gfy127