Ferric Citrate effective in Hyperphosphatemia and Anemia in iron deficient CKD patients

New Delhi: Use of ferric citrate is effective against hyperphosphatemia and anemia in iron-deficient Chronic Kidney Disease (CKD) patients revealed a study published in the Journal of Association of Physicians of India (JAPI).

The results of the study demonstrated a significant elevation in the serum hemoglobin level and a decrease in the serum phosphate level post 3 three month's use of ferric citrate tablets. Serum ferritin and transferrin levels also significantly improved after the intervention.

Anemia is a common threat to CKD patients that happens due to lack of red blood cells. In CKD, kidneys don't make enough of a hormone called erythropoietin (EPO), which our body needs to make red blood cells. The body also needs iron to make red blood cells. Under the shortage of EPO and iron, the body makes fewer red blood cells which eventually leads to anemia and is often manifested in CKD patients. In CKD patients the phosphate hemostasis is also troubled.

Prof Nitya Nand, Dr. Kajaree Giri and Prof Deepak Jain form Pt. B.D. Sharma University of Health Sciences, Rohtak (Haryana) conducted this study which evaluated the role of ferric citrate as an iron supplement to CKD patients suffering from iron deficiency.

"Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients." Prof Nitya Nand, Senior Professor & Head, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak (Haryana), told Medical Dialogues via email.

The authors selected 48 patients matched with the inclusion criteria set by the team. After written consent, detailed history, clinical examination and relevant investigations the patients were given 210 mg of ferric citrate tablet in a dose of 3 tablets per day, to be taken after meals for 12 weeks. Patients were followed up at two weekly intervals and relevant investigations were done. They were divided into three groups according to their CKD stages for subgroup analysis.

"This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5)from a tertiary care center in North India. Patients on intravenous iron, erythropoietin stimulating agents or other phosphate binders were excluded from the study. All the patients were given tablet ferric citrate (each tablet containing ferric citrate 1.1 gm equivalent to ferric iron 210 mg) in a dose of 3 tablets per day for three months. Patients were followed up at two weekly intervals and relevant investigations were done. They were divided into three groups according to their CKD stages for subgroup analysis." said Prof Nitya Nand.

The report analysis of all the 40 patients after the intervention showed an improved hemoglobin, ferritin and transferrin level. The intervention also improved serum vitamin D and serum iPTH levels as well as demonstrated a significant drop in the serum phosphate levels.

"After three months of therapy with ferric citrate, there was a significant decrease in mean serum phosphate from 6.55±0.70 mg/dl at baseline to 4.36±0.50 mg/dl at the end of three months (p<0.001). Mean hemoglobin increased from 7.92±1.05 g/dl at baseline to 10.96±1.04 g/dl at the end of three months (p<0.001).Serum ferritin and serum transferrin saturation increased from 278.25±110.56 ng/dl, 25.02±4.03 % at baseline to 401.24±152.47 ng/dl and 29.62±3.77 % at the end of three months. The mean serum vitamin D and serum iPTH levels, at baseline and at the end of 3 months were 14.61±10.80 ng/ml, 509.48±210.75 pg/ml and 23.65±14.00 ng/ml, 424.14±173.18 pg/ml respectively. The change in all these parameters were significant irrespective of the CKD stages" he adds.

"The present study has shown that ferric citrate is an effective and well-tolerated phosphate binder, which also significantly improves hematologic parameters in an iron-deficient CKD patient," said professor Nitya Nand.

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