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One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis.
J Ren Nutr 2019; 29(5):428-437JR

Abstract

OBJECTIVE

The high pill burden of many phosphate binders (PBs) may contribute to increased prevalence of hyperphosphatemia and poor nutritional status observed among patients undergoing maintenance hemodialysis therapy. We examined the real-world effectiveness of sucroferric oxyhydroxide (SO), a PB with low pill burden, in managing serum phosphorus in patients with prevalent hemodialysis over a 1-year period.

DESIGN

Historical cohort analyses of de-identified electronic medical records.

SUBJECTS

In-center hemodialysis patients switched from another PB to SO therapy as part of routine care with 12 months of uninterrupted SO prescriptions recorded, and documented serum phosphorus levels were eligible for inclusion. Clinical data were extracted from a pharmacy service, FreseniusRx, database and Fresenius Kidney Care clinical data warehouse.

MAIN OUTCOME MEASURES

Comparisons were made between the 91-day period before SO initiation (i.e., baseline) and the 4 consecutive 91-day intervals of SO treatment (Q1-Q4). Clinical measures included achievement of target phosphorus levels (≤5.5 mg/dL) and mean number of PB pills/day.

RESULTS

Among 530 analyzed patients, the proportion achieving target serum phosphorus levels increased by >100% 1 year after switching to SO therapy, that is, from 17.7% at baseline to 24.5%, 30.5%, 36.4%, and 36.0% at Q1 through Q4, respectively (P < .0001 for all). Reductions in serum phosphorus were observed at all follow-up timepoints (P < .0001), irrespective of baseline PB. From a mean baseline PB pill burden of 8.5 pills/day, patients experienced an average 50% pill burden reduction during SO treatment (P < .0001). Phosphorus-attuned albumin and phosphorus-attuned protein intake (normalized protein catabolic rate) improved significantly after transition to SO (P < .0001). The effectiveness of SO was evident in prespecified subgroups of interest (i.e., black/African-American patients, Hispanic/Latino patients, and women).

CONCLUSION

Among patients on hemodialysis, switching to SO resulted in a 2-fold greater likelihood of achieving target phosphorus levels while halving daily PB pill burden. Increases in phosphorus-attuned albumin and protein intake suggest improved nutritional status.

Authors+Show Affiliations

Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Medicine, Denver Health Medical Center, Denver, Colorado.Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts.Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts.Fresenius Medical Care North America, Waltham, Massachusetts.Fresenius Medical Care North America, Waltham, Massachusetts.Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts.Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts.University of California Irvine, School of Medicine, Orange, California. Electronic address: kkz@uci.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30679076

Citation

Kendrick, Jessica, et al. "One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients On Maintenance Hemodialysis." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 29, no. 5, 2019, pp. 428-437.
Kendrick J, Parameswaran V, Ficociello LH, et al. One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis. J Ren Nutr. 2019;29(5):428-437.
Kendrick, J., Parameswaran, V., Ficociello, L. H., Ofsthun, N. J., Davis, S., Mullon, C., ... Kalantar-Zadeh, K. (2019). One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 29(5), pp. 428-437. doi:10.1053/j.jrn.2018.11.002.
Kendrick J, et al. One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients On Maintenance Hemodialysis. J Ren Nutr. 2019;29(5):428-437. PubMed PMID: 30679076.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis. AU - Kendrick,Jessica, AU - Parameswaran,Vidhya, AU - Ficociello,Linda H, AU - Ofsthun,Norma J, AU - Davis,Shannon, AU - Mullon,Claudy, AU - Kossmann,Robert J, AU - Kalantar-Zadeh,Kamyar, Y1 - 2019/01/21/ PY - 2018/07/13/received PY - 2018/11/11/revised PY - 2018/11/20/accepted PY - 2020/09/01/pmc-release PY - 2019/1/27/pubmed PY - 2019/1/27/medline PY - 2019/1/26/entrez SP - 428 EP - 437 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 29 IS - 5 N2 - OBJECTIVE: The high pill burden of many phosphate binders (PBs) may contribute to increased prevalence of hyperphosphatemia and poor nutritional status observed among patients undergoing maintenance hemodialysis therapy. We examined the real-world effectiveness of sucroferric oxyhydroxide (SO), a PB with low pill burden, in managing serum phosphorus in patients with prevalent hemodialysis over a 1-year period. DESIGN: Historical cohort analyses of de-identified electronic medical records. SUBJECTS: In-center hemodialysis patients switched from another PB to SO therapy as part of routine care with 12 months of uninterrupted SO prescriptions recorded, and documented serum phosphorus levels were eligible for inclusion. Clinical data were extracted from a pharmacy service, FreseniusRx, database and Fresenius Kidney Care clinical data warehouse. MAIN OUTCOME MEASURES: Comparisons were made between the 91-day period before SO initiation (i.e., baseline) and the 4 consecutive 91-day intervals of SO treatment (Q1-Q4). Clinical measures included achievement of target phosphorus levels (≤5.5 mg/dL) and mean number of PB pills/day. RESULTS: Among 530 analyzed patients, the proportion achieving target serum phosphorus levels increased by >100% 1 year after switching to SO therapy, that is, from 17.7% at baseline to 24.5%, 30.5%, 36.4%, and 36.0% at Q1 through Q4, respectively (P < .0001 for all). Reductions in serum phosphorus were observed at all follow-up timepoints (P < .0001), irrespective of baseline PB. From a mean baseline PB pill burden of 8.5 pills/day, patients experienced an average 50% pill burden reduction during SO treatment (P < .0001). Phosphorus-attuned albumin and phosphorus-attuned protein intake (normalized protein catabolic rate) improved significantly after transition to SO (P < .0001). The effectiveness of SO was evident in prespecified subgroups of interest (i.e., black/African-American patients, Hispanic/Latino patients, and women). CONCLUSION: Among patients on hemodialysis, switching to SO resulted in a 2-fold greater likelihood of achieving target phosphorus levels while halving daily PB pill burden. Increases in phosphorus-attuned albumin and protein intake suggest improved nutritional status. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/30679076/One-Year_Historical_Cohort_Study_of_the_Phosphate_Binder_Sucroferric_Oxyhydroxide_in_Patients_on_Maintenance_Hemodialysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(18)30254-1 DB - PRIME DP - Unbound Medicine ER -