In a real-world study, patients on peritoneal dialysis (PD) who were prescribed the iron-based phosphate binder sucroferric oxyhydroxide significantly reduced their serum phosphorus levels and pill burden.
Kamyar Kalantar-Zadeh, MD, MPH, PhD, and his colleagues investigated sucroferric oxyhydroxide’s efficacy in 258 PD patients (mean age 50.6 years; dialysis vintage 29.3 months) from Fresenius’ prescription and health record databases. During routine care, patients were switched from sevelamer, calcium acetate, or lanthanum carbonate, or received sucroferric oxyhydroxide as their first phosphate binder. At baseline, mean serum phosphorus was 6.59 mg/dL and phosphate binder (PB) burden was 10 pills/day.
Only 25% to 30% patients had in-range serum phosphorus of 5.5 mg/dL or less at baseline. With 6 months of sucroferric oxyhydroxide treatment, that proportion rose to 40%. In addition, this subgroup required fewer pills (4.3 pills/day).
“The proportion of patients achieving in-range serum phosphorus increased by 72% from baseline to month 6,” Dr Kalantar-Zadeh’s team reported in the American Journal of Nephrology (2018;47:153–161). “Prescribed PB pills/day decreased by 57%.”
In patients with hyperphosphatemia who reached target levels with sucroferric oxyhydroxide, serum phosphorus levels dropped significantly from 6.54 to 5.10 mg/dL and mean daily pill burden dropped from 9.9 to 4.7 pills/day, a 53% decrease.
“Nonadherence to prescribed PB regimen has been reported in 62% of dialysis patients,” Dr Kalantar-Zadeh and his colleagues. “PB pill burden is a cited determinant of PB adherence. Thus, that the observed average pill burden decreased from 10 to 5 pills/day is favorable.”
Since dietary protein restriction and residual renal function can influence phosphorus control, the investigators assessed their relative contributions. In patients with phosphorus levels at goal, both phosphorus-attuned serum albumin and normalized protein catabolic rate improved during treatment. In addition, patients with higher residual renal function at baseline were more likely to have in-range phosphorus levels.
Over the study period, a few patients switched from sucroferric oxyhydroxide or stopped taking binders. The reasons for the switch or discontinuation were not available, which is a study limitation.
Fresenius Medical Care North America Renal Therapies Group, which manufactures sucroferric oxyhydroxide (Velphoro) provided funding for the study. Several authors disclosed financial relationships with the company.
Kalantar-Zadeh K, Parameswaran V, Ficociello LH, et al. Real-world scenario improvements in serum phosphorus levels and pill burden in peritoneal dialysis patients treated with sucroferric oxyhydroxide. Am J Nephrol 2018;47:153–161. DOI: 10.1159/000487856