Iron-Based Binder Improves Phosphorus, FGF-23, and Anemia
Clinicians were able to reduce doses of erythropoiesis-stimulating agents and intravenous iron.
In a new study, patients receiving hemodialysis or hemodiafiltration who switched to the iron-based phosphate-binder sucroferric oxyhydroxide experienced improvement in serum phosphorus, fibroblast growth factor 23 (FGF-23), and anemia over 16 weeks.
Thirty-three patients who were still hyperphosphatemic after therapy with lanthanum carbonate or calcium carbonate were switched to sucroferric oxyhydroxide with or without calcium carbonate for 16 weeks. Serum phosphorus levels fell by week 8, Hisato Shima, MD, and colleagues from Kawashima Hospital in Japan reported in BMC Research Notes. By week 16, FGF23 also decreased, and hemoglobin increased. Clinicians were able to reduce doses of erythropoiesis-stimulating agents and intravenous iron.
The early drop in phosphorus levels may reflect the dosage of sucroferric oxyhydroxide per tablet, which is the highest of all phosphate binders in Japan, according to the investigators. FGF-23, a potential risk factor for cardiovascular events, improved with treatment possibly due to relief of iron deficiency.
Another 21 patients discontinued sucroferric oxyhydroxide before week 16 due to adverse events and other factors, which is a study limitation. Among study completers, the most common drug-related complaint was diarrhea, which occurred in 16.7% of patients. Iron levels increased to week 16 among completers, indicating that monitoring may be necessary to prevent iron overdose from sucroferric oxyhydroxide.
“Based on the results, sucroferric oxyhydroxide can be regarded as a drug that can safely control serum phosphorus levels when given as a 16-week treatment course,” Dr Shima's team stated. The addition of calcium carbonate did not affect results in subgroup analyses.
The study was funded by Kissei Pharmaceutical Co., Ltd, which manufactures sucroferric oxyhydroxide in Japan.
Shima H, Miya K, Okada K, Minakuchi J, and Kawashima S. Sucroferric oxyhydroxide decreases serum phosphorus level and fibroblast growth factor 23 and improves renal anemia in hemodialysis patients. BMC Res Notes 2018;11:363. DOI: 10.1186/s13104-018-3483-6