Abstract
Ferric citrate hydrate was recently approved in Japan as an oral phosphate binder to be taken with food for the control of hyperphosphatemia in patients with chronic kidney disease (CKD). The daily therapeutic dose is about 3 to 6 g, which comprises about 2 to 4 g of citrate. Oral citrate solubilizes aluminum that is present in food and drinking water, and opens the tight junctions in the intestinal epithelium, thereby increasing aluminum absorption and urinary excretion. In healthy animals drinking tap water, oral citrate administration increased aluminum absorption and, over a 4-week period, increased aluminum deposition in brain and bone by about 2- and 20-fold, respectively. Renal excretion of aluminum is impaired in patients with chronic kidney disease, thereby increasing the risk of toxicity. Based on human and animal studies it can be surmised that patients with CKD who are treated with ferric citrate hydrate to control hyperphosphatemia are likely to experience enhanced absorption of aluminum from food and drinking water, thereby increasing the risk of aluminum overload and toxicity.
Highlights
Ferric citrate hydrate (Riona®, Japan Tobacco Inc, Tokyo, Japan) was recently approved by the Japanese Ministry of Health, Labour and Welfare, as a phosphate binder for the improvement of hyperphosphatemia both in patients with dialysis and in patients with non-dialysis dependent chronic kidney disease (CKD) [1,2]
The aim of this commentary is to demonstrate that large doses of citrate, administered as ferric citrate hydrate 2 to 3 times a day to patients with CKD, are expected to significantly increase aluminum absorption and increase the risk of aluminum toxicity
Regular clinical and laboratory monitoring for aluminum overload and toxicity is needed when ferric citrate hydrate is used as a phosphate binder, especially in patients with a high dietary intake of aluminum
Summary
Ferric citrate hydrate (Riona®, Japan Tobacco Inc, Tokyo, Japan) was recently approved by the Japanese Ministry of Health, Labour and Welfare, as a phosphate binder for the improvement of hyperphosphatemia both in patients with dialysis and in patients with non-dialysis dependent chronic kidney disease (CKD) [1,2]. The doses of elemental iron III [Fe(III)] as ferric citrate needed for effective. The maximum daily oral dose of 6000 mg of ferric citrate hydrate would administer about 3900 mg of citrate and 1000 mg Fe(III). Renal elimination of aluminum is impaired in patients who have reduced glomerular filtration rate [3] The aim of this commentary is to demonstrate that large doses of citrate, administered as ferric citrate hydrate 2 to 3 times a day to patients with CKD, are expected to significantly increase aluminum absorption and increase the risk of aluminum toxicity. Regular clinical and laboratory monitoring for aluminum overload and toxicity is needed when ferric citrate hydrate is used as a phosphate binder, especially in patients with a high dietary intake of aluminum
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
