Next-generation phosphate binders: focus on iron-based binders.
Phosphate excess is associated with increased mortality in patients with chronic kidney disease (CKD) and has recently been linked to accelerated aging. Oral phosphate binders are prescribed to patients with CKD to prevent absorption of dietary phosphate. Currently available binders have been associated with impaired outcomes (calcium-based binders) or are expensive (non-calcium-based binders). Iron-based phosphate binders represent a new class of phosphate binders. Four iron-based phosphate binders have undergone testing in clinical trials. The development of fermagate and SBR759 is currently on hold due to suboptimal and adverse effect profiles in at least some clinical trials. Ferric citrate and sucroferric oxyhydroxide (PA21) are at different stages of application for regulatory approval after being found safe and efficacious in decreasing serum phosphate. Iron from ferric citrate is more readily absorbed than that from sucroferric oxyhydroxide. Sucroferric oxyhydroxide was launched in the USA in 2014 for the treatment of hyperphosphatemia in adult dialysis patients. Ferric citrate may be more suited for chronic treatment of hyperphosphatemia in CKD patients requiring iron supplements but its use may have to be limited in time because of potential for iron overload in patients not needing iron or not receiving erythropoiesis-stimulating agents. In contrast, sucroferric oxyhydroxide may be more suited for hyperphosphatemic CKD patients not requiring iron supplements.
Hellenic Red Cross Hospital, Athens, Greece.
Dimitra
D
Nastou
Beatriz
B
Fernández-Fernández
Usama
U
Elewa
Liliana
L
González-Espinoza
Emilio
E
González-Parra
Maria D
MD
Sanchez-Niño
Alberto
A
Ortiz
D000328:Adult; D000818:Animals; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D058085:Iron Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D010710:Phosphates / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality
D002614:Chelating Agents; D058085:Iron Compounds; D010710:Phosphates