WASHINGTON—Reducing serum phosphate levels to 3.5 to 4.5 mg/dL in patients on hemodialysis (HD) may slow the progression of coronary artery calcification (CAC), researchers concluded in a presentation at at the American Society of Nephrology’s Kidney Week 2019.

In EPISODE (Evaluate the new Phosphate Iron-based binder Sucroferric Oxyhydroxide in Dialysis patients), 160 HD patients were randomly assigned to the noncalcium phosphate binder sucroferric oxyhydroxide or lanthanum carbonate with the aim of reducing serum phosphate to either 3.5 to 4.5 mg/dL (strict arm) or 5.0 to 6.0 mg/dL (standard arm) over 12 months. The median CAC score at baseline was 840.

Yoshitaka Isaka, MD, PhD, of Osaka University Graduate School of Medicine in Suita, Japan, and his colleagues found no significant difference in the change in CAC score between the 2 binders at 12 months: sucroferric oxyhydroxide median 12.46% vs lanthanum carbonate 13.23%. But the strict control group (achieved serum phosphate 4.98 mg/dL) had a significantly slower increase in CAC compared with the standard control group (achieved serum phosphate 5.61 mg/dL). The median CAC score change was 7.57% vs 20.16%, respectively.

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Patients with strict phosphate control also had significantly decreased c-terminal fibroblast growth factor 23 compared with the standard control group (-130.31 vs 168.69 pmol/L).

Even the subgroup of HD patients with baseline CAC score exceeding 1000 benefited significantly from strict vs standard phosphate control: change in CAC score 4.87% vs 11.88%, respectively.

The study was funded by Kissei Pharmaceutical, the developers of chewable sucroferric oxyhydroxide in Japan.

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Isaka Y, Hamano T, Fujii H, et al. A randomized trial of optimal phosphate range for coronary artery calcification in dialysis patients. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5 to 10, 2019, in Washington DC. Abstract FR-OR031.

Isaka Y, Fujii H, Tsujimoto Y, et al. Rationale, design, and characteristics of a trial to evaluate the new phosphate iron-based binder sucroferric oxyhydroxide in dialysis patients with the goal of advancing the practice of E.B.M. (EPISODE). Clin Exper Nephrol. August 2018;22:967-972.

https://link.springer.com/article/10.1007%2Fs10157-018-1547-5 Launch of “P-TOL® Granules” for the Treatment of Hyperphosphatemia. Kissei Pharmaceuticals; November 27, 2018. Accessed at https://www.kissei.co.jp/e_contents/news/2018/20181127-2622.html