Phosphate binders in dialysis: better satisfied than sorry

Cozzolino, Mario; Galassi, Andrea; Ciceri, Paola

doi:10.1093/ckj/sfab093

Cited by 2 publications

(2 citation statements)

References 10 publications

(11 reference statements)

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“…Such data highlight the need for early and prolonged reduction of sP. It is recognized that patient satisfaction with a PB can impact adherence, sP concentrations, and ultimately, the risk of death [ 29 , 30 ]. Data on the impact of PB use and its effect on mortality among incident dialysis patients are scant.…”

Section: Discussionmentioning

confidence: 99%

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

Medaura,

Zhou,

Ficociello

et al. 2023

Am J Nephrol

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Introduction: Sucroferric oxyhydroxide (SO), a non-calcium, chewable, iron-based phosphate binder (PB), effectively lowers serum phosphorus (sP) concentrations while reducing pill burden relative to other PBs. To date, SO studies have largely examined treatment-experienced, prevalent hemodialysis populations. We aimed to explore the role of first-line SO initiated during the first year of dialysis. Methods: We retrospectively analyzed de-identified data from adults receiving in-center hemodialysis who were prescribed SO monotherapy within the first year of hemodialysis as part of routine clinical care. All patients continuing SO monotherapy for 12 months were included. Changes from baseline in sP, achievement of sP ≤5.5 and ≤4.5 mg/dL, and other laboratory parameters were analyzed quarterly for one year. Results: The overall cohort included 596 patients, 286 of whom had a dialysis vintage ≤3 months. In the 3 months preceding SO initiation, sP rapidly increased (mean increases of 1.02 mg/dL and 1.65 mg/dL, in the overall cohort and incident cohort, respectively). SO treatment was associated with significant decreases in quarterly sP (mean decreases of 0.26-0.36; p<0.0001 for each quarter and overall). While receiving SO, 55%-60% of patients achieved sP ≤5.5 mg/dL and 21%-24% achieved sP ≤4.5 mg/dL (p<0.0001 for each quarter and overall vs baseline). Daily PB pill burden was approximately 4 pills. Serum calcium concentrations increased and intact parathyroid hormone concentrations decreased during SO treatment (p<0.0001 vs baseline). Conclusions: Among patients on hemodialysis, initiating SO as a first-line PB resulted in significant reductions in sP while maintaining a relatively low PB pill burden.

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Section: Discussionmentioning

confidence: 99%

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

Medaura,

Zhou,

Ficociello

et al. 2023

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…High pill burden is a wellrecognized barrier to adherence in hemodialysis patients, 8 a population already burdened with a high daily pill intake that may exceed 20 pills/day. 26 A number of studies have shown PB pill burden to correlate inversely with sP control. 27,28 A recent Dialysis Outcomes and Practice Patterns Study (DOPPS) analysis of 895 European hemodialysis patients found that self-reported difficulty, inconvenience, and dissatisfaction in taking PB medication were associated with higher odds of having sP ≥6 mg/dl.…”

Section: Discussionmentioning

confidence: 99%

Serum Phosphorus and Pill Burden Among Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide: One-Year Follow-Up on a Contemporary Cohort

Kendrick¹,

Zhou²,

Ficociello³

et al. 2022

IJNRD

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In prior analyses of real-world cohorts of hemodialysis patients switched from one phosphate binder (PB) to sucroferric oxyhydroxide (SO), SO therapy has been associated with improvements in serum phosphorus (sP) and reductions in daily PB pill burden. To characterize how SO initiation patterns have changed over time, we examined the long-term effectiveness of SO in a contemporary (2018-2019) cohort. Patients and Methods: Adult Fresenius Kidney Care hemodialysis patients first prescribed SO monotherapy as part of routine care between May 2018 and May 2019 (N = 1792) were followed for 1 year. All patients received a non-SO PB during a 91-day baseline period before SO prescription. Mean PB pills/day and laboratory parameters were compared before and during SO treatment. Results were divided into consecutive 91-day intervals (Q1-Q4) and analyzed using linear mixed-effects regression and Cochran's Q test. These results were contrasted with findings from a historical (2014-2015) cohort (N = 530). Results: The proportion of patients achieving sP ≤5.5 mg/dl increased after switching to SO (from 27.0% at baseline to 37.8%, 45.1%, 44.7%, and 44.0% at Q1, Q2, Q3, and Q4, respectively; P < 0.0001 for all). The mean daily PB pill burden decreased from a baseline of 7.7 to 4. 4, 4.6, 4.8, and 4.9, respectively, across quarters (P < 0.0001 for all). Patients in the contemporary cohort had improved sP control (27.0% achieving sP ≤5.5 mg/dl vs 17.7%) and lower daily PB pill burden (mean 7.7 vs 8.5 pills/day) at baseline than those in the historical cohort. Overall use of active vitamin D was similar between cohorts, although higher use of oral active vitamin D (63.9% vs 15.7%) and lower use of IV active vitamin D lower (23.4% vs 74.2%) was observed in the contemporary cohort. Conclusion: Despite evolving treatment patterns, switching to SO resulted in improved sP control with fewer pills per day in this contemporary hemodialysis cohort.

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Phosphate binders in dialysis: better satisfied than sorry

Cited by 2 publications

References 10 publications

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

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

Serum Phosphorus and Pill Burden Among Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide: One-Year Follow-Up on a Contemporary Cohort

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