A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care

Abstract

Objective Despite the growing number of elderly hemodialysis patients, the influence of age on nutritional parameters, serum phosphorus (sP), and use of phosphate-binder (PB) medications has not been well characterized. We aimed to describe age-related differences in patient characteristics in a large, real-world cohort of maintenance hemodialysis patients, and to examine the impact of age on sP management with sucroferric oxyhydroxide (SO). Methods We retrospectively analyzed de-identified data from 2017 adult, in-center hemodialysis patients who switched from another PB to SO monotherapy as part of routine clinical care. Changes in baseline PB pill burden, sP levels, and nutritional and dialytic clearance parameters were assessed across varying age groups through 6 months. Results At baseline, older patients had lower mean sP, serum albumin, and pre-dialysis weights compared with younger patients. Prescription of SO was associated with a 62% increase in the proportion of patients achieving sP ≤ 5.5 mg/dl and a 42% reduction in daily pill burden. The proportion of patients achieving sP ≤ 5.5 mg/dl after transitioning to SO increased by 113, 96, 68, 77, 61, 37 and 40% among those aged 19–29, 30–39, 40–49, 50–59, 60–69, 70–79, and ≥ 80 years, respectively. Conclusions Older patients had worse nutritional parameters, lower pill burden, and lower sP at baseline versus younger counterparts. Prescription of SO was associated with improved sP control and reduced pill burden across all ages.

Serum Phosphorus Management with Sucroferric Oxyhydroxide as a First-Line Phosphate Binder within the First Year of Hemodialysis

“…Because even very low glomerular filtration rates can contribute to endogenous clearance of phosphorus [ 13 , 14 ], changes in residual kidney function likely impacted phosphorus control during our study. Although the trajectory of residual kidney function decline in hemodialysis has not been well studied [ 23 ] and measures of residual function were not collected in this study, we would expect kidney function to decline over time.…”

“…In data from April 2014 to March 2015, Coyne et al [ 18 ] studied a cohort with a mean baseline sP concentration of 6.93 mg/dL. Using data from May 2018 to May 2019, Rhee et al [ 14 ] and Kendrick et al [ 27 ] studied cohorts with mean baseline sP concentrations of 6.39 mg/dL and 6.38 mg/dL, respectively. These sP concentrations were similar to −1 month concentrations observed in the present analysis (6.25 mg/dL).…”

“…As a result of residual kidney function, incident hemodialysis populations may have improved physiologic phosphate control (and less need for pharmacotherapy) at the start of dialysis. As residual kidney function declines over time, the need for pharmacotherapy increases [12][13][14].…”

“…Sucroferric oxyhydroxide (SO, 500 mg per tablet; Velphoro ® , Fresenius Medical Care Renal Therapies Group, Waltham, MA, USA) is a non-calcium, chewable, iron-based PB that effectively lowers sP while reducing pill burden relative to other PBs. To date, studies have largely examined the effects of SO in prevalent hemodialysis populations previously treated with other PBs [14][15][16][17][18][19][20][21]. This study aimed to explore the role of SO as a first-line PB among patients in their first year of dialysis.…”