One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis.
Adult
Aged
Chelating Agents
/ therapeutic use
Cohort Studies
Drug Combinations
Female
Ferric Compounds
/ therapeutic use
Humans
Hyperphosphatemia
/ drug therapy
Male
Medication Adherence
Middle Aged
Nutritional Status
Phosphates
/ blood
Phosphorus
/ blood
Renal Dialysis
Renal Insufficiency
/ blood
Sucrose
/ therapeutic use
Time Factors
Treatment Outcome
Journal
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
ISSN: 1532-8503
Titre abrégé: J Ren Nutr
Pays: United States
ID NLM: 9112938
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
13
07
2018
revised:
11
11
2018
accepted:
20
11
2018
pubmed:
27
1
2019
medline:
21
8
2020
entrez:
26
1
2019
Statut:
ppublish
Résumé
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. Historical cohort analyses of de-identified electronic medical records. 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. 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. 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). 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.
Identifiants
pubmed: 30679076
pii: S1051-2276(18)30254-1
doi: 10.1053/j.jrn.2018.11.002
pmc: PMC6642852
mid: NIHMS1038445
pii:
doi:
Substances chimiques
Chelating Agents
0
Drug Combinations
0
Ferric Compounds
0
Phosphates
0
sucroferric oxyhydroxide
0
Phosphorus
27YLU75U4W
Sucrose
57-50-1
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
428-437Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL132868
Pays : United States
Informations de copyright
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
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