MO809: Sucroferric Oxyhydroxide for the Management of Hyperphosphataemia in Peritoneal Dialysis Patients

Abstract

Abstract BACKGROUND AND AIMS Bone and mineral metabolism disorders are very common in chronic kidney disease (CKD) patients. The increase in phosphorus levels leads to bone disease, risk of calcification and higher mortality, so any strategy aimed at reducing it should be welcomed. The latest drug added to the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SO). Our objective was to analyse the efficacy and safety of SO in patients with CKD on peritoneal dialysis (PD), followed for 6 months. METHOD Observational, multicentre, prospective, clinical practice study. Patients who had been on PD for >6 months and who had been prescribed SO as a treatment for hyperphosphataemia were included; they should also meet any of the following conditions: serum phosphate >4.5 mg/dL, serum phosphate ≤4.5 mg/dL but receiving a high number of tablets or using another phosphate binder with adverse effects or intolerance. Clinical and epidemiological variables were analysed; also parameters related to bone and mineral metabolism disorders and anaemia. Variations in stool consistency and the need for laxatives were also taken into account. RESULTS A total of 92 patients (62 ± 14 years, 66% male, 23% diabetic), from 11 centres, were included in the study. In 66 patients (72%), SO was the first phosphate binder; in the other 26, a previous binder was replaced by SO due to lack of tolerance or efficacy. The initial dose of SO was 942 ± 516 mg/day. Globally, serum phosphate levels decrease at 3 (10.7%, P < .001) and at 6 months of treatment (18.3%, P < .001). After 6 months of treatment, 63% of the patients achieved a phosphataemia of <5 mg/dL and 41% <4.5 mg/dL. The decrease in serum phosphate levels correlated with baseline phosphate level (r = 0.367; P = .039), age (r = .338; P = .033) and time on dialysis (r = 0.578; P = 0.001). There were no differences in the efficacy of the drug when comparing the different populations analysed. Serum levels of calcium, iPTH, ferritin, transferrin saturation index and haemoglobin did not change throughout the study. Stool consistency was reduced, and the need for laxatives decreased by 18%. The mean dose of SO increased over time to 1167 ± 381 mg/day. The drug was well tolerated. CONCLUSION SO is an effective option for the treatment of hyperphosphataemia in PD patients. Age, basal phosphate levels and time in the technique are factors associated with a greater decrease in serum phosphate levels. Stool consistency became softer (which may improve dialysis efficiency) with less need for laxatives.