Faculty Collaboration Database

Dose-response and efficacy of ferric citrate to treat hyperphosphatemia in hemodialysis patients: a short-term randomized trial. Am J Kidney Dis 2013 May;61(5):759-66

Date

02/02/2013

Pubmed ID

23369827

DOI

10.1053/j.ajkd.2012.11.041

Scopus ID

2-s2.0-84876295026 (requires institutional sign-in at Scopus site)   50 Citations

Abstract

BACKGROUND: Most dialysis patients require phosphate binders to control hyperphosphatemia. Ferric citrate has been tested in phase 2 trials as a phosphate binder. This trial was designed as a dose-response and efficacy trial.

STUDY DESIGN: Prospective, phase 3, multicenter, open-label, randomized clinical trial.

SETTING & PARTICIPANTS: 151 participants with hyperphosphatemia on maintenance hemodialysis therapy.

INTERVENTION: Fixed dose of ferric citrate taken orally as a phosphate binder for up to 28 days (1, 6, or 8 g/d in 51, 52, and 48 participants, respectively).

OUTCOMES: Primary outcome is dose-response of ferric citrate on serum phosphorus level; secondary outcomes are safety and tolerability.

MEASUREMENTS: Serum chemistry tests including phosphorus, safety data.

RESULTS: 151 participants received at least one dose of ferric citrate. Mean baseline phosphorus levels were 7.3 ± 1.7 (SD) mg/dL in the 1-g/d group, 7.6 ± 1.7 mg/dL in the 6-g/d group, and 7.5 ± 1.6 mg/dL in the 8-g/d group. Phosphorus levels decreased in a dose-dependent manner (mean change at end of treatment, -0.1 ± 1.3 mg/dL in the 1-g/d group, -1.9 ± 1.7 mg/dL in the 6-g/d group, and -2.1 ± 2.0 mg/dL in the 8-g/d group). The mean difference in reduction in phosphorus levels between the 6- and 1-g/d groups was 1.3 mg/dL (95% CI, 0.69 to 1.9; P < 0.001), between the 8- and 1-g/d groups was 1.5 mg/dL (95% CI, 0.86 to 2.1; P < 0.001), and between the 8- and 6-g/d groups was 0.21 mg/dL (95% CI, -0.39 to 0.81; P = 0.5). The most common adverse event was stool discoloration.

LIMITATIONS: Sample size and duration confirm efficacy, but limit our ability to confirm safety.

CONCLUSIONS: Ferric citrate is efficacious as a phosphate binder in a dose-dependent manner. A phase 3 trial is ongoing to confirm safety and efficacy.

Author List

Dwyer JP, Sika M, Schulman G, Chang IJ, Anger M, Smith M, Kaplan M, Zeig S, Koury MJ, Blumenthal SS, Lewis JB, Collaborative Study Group

Author

Samuel S. Blumenthal MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Administration, Oral
Dose-Response Relationship, Drug
Female
Ferric Compounds
Follow-Up Studies
Hematinics
Humans
Hyperphosphatemia
Kidney Failure, Chronic
Male
Middle Aged
Phosphorus
Prospective Studies
Renal Dialysis
Time Factors
Treatment Outcome