Abstract
Ferric citrate has been reported to have the potential to reduce phosphate and increase iron availability in patients with chronic kidney disease. In the present study, we evaluated its safety and efficacy in phosphate reduction and iron supplementation in chronic kidney disease stage 3-5 requiring dialysis patients. We systematically searched for clinical trials published in PubMed, Medline, and Cochrane databases. Only randomized controlled trials on the effects of ferric citrate in chronic kidney disease stage 3–5 requiring dialysis patients were selected. The primary outcomes were changes in serum phosphate, calcium, and anemia-related parameters. The secondary outcomes were the adverse effects of ferric citrate. Nine studies providing data on 1755 patients were included in the meta-analysis. Ferric citrate significantly reduced serum phosphate compared with placebo (mean difference, –1.39; 95% confidence interval, –2.12 to –0.66) and had a non-inferior effect compared with active treatment. Furthermore, ferric citrate significantly improved hemoglobin, transferrin saturation and ferritin. Adverse effects of constipation did not differ significantly between ferric citrate and placebo or active treatment. This review provides evidence that ferric citrate effectively alleviates hyperphosphatemia and iron deficiency in patients with chronic kidney disease stage 3–5 requiring dialysis patients. However, the included studies did not have cardiovascular complications or mortality information and could not assess whether ferric citrate affected the risk of all-cause death or cardiovascular complications in patients with chronic kidney disease. Further studies are required to assess whether the long-term use of ferric citrate can reduce the risk of cardiovascular events and all-cause mortality.
Highlights
Chronic kidney disease (CKD), a worldwide health burden, consumes disproportionate health care resources
The present systematic review of 9 randomized controlled trials (RCTs) involving 1755 participants provides evidence suggesting that a course of Ferric citrate (FC) treatment in patients with CKD stage 3–chronic kidney disease treated with dialysis (5D) is beneficial in alleviating hyperphosphatemia and anemia
In patients with CKD, calcium-free phosphate binders were reported to be associated with a decreased risk of all-cause mortality compared with their calcium-based counterparts [23]
Summary
Chronic kidney disease (CKD), a worldwide health burden, consumes disproportionate health care resources. Secondary hyperparathyroidism, and cardiovascular disease are highly prevalent in patients with CKD. Anemia and hyperphosphatemia are potentially modifiable risk factors for CKD progression www.impactjournals.com/oncotarget and mortality [1, 2]. Anemia is frequently associated with a higher risk of cardiovascular events and all-cause mortality [3, 4]. The causes of anemia in patients with CKD include erythropoietin and iron deficiency, inflammation-malnutrition complex, shortened red blood cell lifespan, and increased blood loss [5]. Treatment with erythropoiesis-stimulating agents (ESAs) benefited patients with CKD and reduced the need for frequent blood transfusion. Hyperphosphatemia causes vascular and valvular calcification, thereby increasing the risk of peripheral arterial disease and hospitalization for heart failure in patients with CKD
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