Regional prescription surveillance of phosphate binders in the western Saitama area: the substantial role of ferric citrate hydrate in improving serum phosphorus levels and erythropoiesis

• Published in: Clinical and experimental nephrology Vol. 23; no. 6; pp. 841 - 851
• Main Authors: Amano, Hiroaki, Ohno, Yoichi, Inoue, Tsutomu, Tomori, Koji, Ohama, Kazuya, Okada, Hirokazu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-06-2019; Springer Nature B.V
• Subjects: Aged; Calcium carbonate; Citric acid; Drug Prescriptions; Erythropoiesis; Female; Ferric citrate; Ferric Compounds - pharmacology; Hemodialysis; Hemoglobin; Humans; Japan; Lanthanum; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Parathyroid; Parathyroid hormone; Phosphates - antagonists & inhibitors; Phosphates - blood; Phosphorus; Renal Dialysis; Retrospective Studies; Surveillance; Urology; Japan; Chronic kidney disease-mineral and bone disorder (CKD-MBD); Polypharmacy; Ferric citrate hydrate; Phosphate binder (PB)
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-019-01715-8

Background
In April 2015, five types of phosphate binders (PBs) were available by prescription in Japan, namely calcium carbonate, sevelamer hydrochloride, lanthanum carbonate, bixalomer, and ferric citrate hydrate (FeC). FeC reduces serum phosphorus levels and increases the body’s iron stores. However, it is unclear whether FeC lowers serum phosphorus relative to other agents in a regional practical setting.
Methods
We performed a retrospective observational cohort study of regional hemodialysis surveillance in the western Saitama area of Japan, which included 1374 hemodialysis patients enrolled from 32 satellite dialysis units. The clinical data and prescribing information were retrospectively collected and analyzed. The difference in serum phosphorus among the groups administered five types of PBs (new or additional) from April to September 2015 was the primary outcome.
Results
As of April 2015, the median values of serum phosphorus, corrected calcium, and intact parathyroid hormone were 5.4 mg/dL, 9.1 mg/dL, and 147 pg/dL, respectively (
N
 = 1374). Unexpectedly, with an increase in the number of PBs administered, serum phosphorous levels increased (
p
 < 0.001). The significant changes in the serum phosphorus and hemoglobin levels were associated with the prescription of FeC but not with that of the other PBs.
Conclusions
This regional survey suggests that serum phosphorus is well managed and that FeC has the potential to reduce the serum phosphorus level relative to other PBs and to ameliorates anemia.