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

Abstract

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.

Management of serum phosphorus over a 1-year follow-up in patients on peritoneal dialysis prescribed sucroferric oxyhydroxide as part of routine care: a retrospective analysis

“…In this real-world retrospective cohort study, PD patients prescribed SO as part of routine clinical care over a 1-year period experienced significant reductions in sP and PB pills per day, and increases in the percentage of patients who achieved sP ≤ 5.5 mg/dL or sP ≤ 4.5 mg/dL, suggesting improved sP management with a concurrent reduction in pill burden. These findings are consistent with our observations in a smaller cohort of patients on PD in 2014–2015 and the results of previous studies in patients on PD or hemodialysis [ 11 – 13 , 15 , 16 ]. Compared to our previous real-world analysis of SO initiation in patients on PD in 2014–2015, patients in the completers cohort of the current study were older (55.2 vs. 50.6 years) but were newer to dialysis (19.9 vs. 29.3 months) and had lower sP at baseline (6.26 vs. 6.59 mg/dL).…”

“…In this study, increases in levels of phosphorus-attuned albumin in the context of no changes in nPCR suggest that SO reduced sP without adverse changes in nutritional status. It has been suggested that dietary intake may improve with SO vs. other binders, given the impact of regimens with higher pill burdens on appetite [ 16 ]. A recent pilot clinical practice study documented similar increases in phosphorus-attuned albumin but did not find any significant changes in patient-reported appetite or dietary intake among PD patients initiating SO [ 13 ].…”

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

“…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).…”