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Abstract: SA-PO818

A Prospective Study Examining the Contribution to Renal Anemia Treatment of Ferric Citrate Hydrate, an Iron-Based Oral Phosphate Binder, in Hemodialysis Patients with Hyperphosphatemia: ASTRIO Study

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Yokoyama, Keitaro, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, KANAGAWA, Japan
  • Akiba, Takashi, Sekikawa Hospital, Tokyo, Japan
  • Nakayama, Masaaki, Tohoku University, Tohoku University Hospital, Sendai City, Japan
  • Hanaki, Koji, JAPAN TOBACCO INC., Tokyo, Japan
  • Kyoko, Ito, Torii Pharmaceutical Co., Ltd, Tokyo, Japan
  • Hirakata, Hideki N., Fukuoka Renal Clinic, Fukuoka City, Japan

We conducted a prospective study examining the contribution to renal anemia treatment of Ferric citrate hydrate (FC) compared with non-iron-based oral phosphate binders (Control), in HD patients with hyperphosphatemia undergoing ESA therapy.


The study was designed as a multicenter, open-label, active-controlled, randomized, parallel-arm comparison study. HD patients who had been used non-iron-based oral phosphate binders were randomized to FC group (n=45) or Control group (n=48). In FC group, previous treatment was discontinued at registration and switched to FC, and continued for 24 weeks. In Control group, previous treatment was continued. Serum P and Hb were controlled in the target ranges of 3.5 to 6.0 mg/dL and 10.0 to 12.0 g/dL, respectively. We have evaluated the doses of ESA and IV iron.


Mean changes in ESA dose (IU/week) from baseline to end of treatment (EOT) were –1211.8±3609.5 in FC group and 1195.5±6662.8 in Control group. It was significantly lower in FC group than Control group (p=0.0386). Cumulative dose of IV iron from baseline to Week 24 was also significantly lower in FC group than Control group (p=0.0065). Other parameters are shown in the table.


We confirmed that FC decreased doses of ESA and IV iron. We also confirmed the differences of ERI, MCV, RDW and FGF23 between FC group and Control group. It was considered iron supplementation by FC was done in functional manner. FC is expected to contribute to renal anemia treatment and hematopoietic.

ParameterFC group (N=40)
Change (from baseline to EOT)
Control group (N=42)
Change (from baseline to EOT)
Adjusted Mean Difference (FC minus Control)p-value
Serum P (mg/dL)0.24-0.170.550.0643
Hb (g/dL)0.450.340.170.5065
TSAT (%)
Serum ferritin (ng/mL)79.02.979.5<0.0001
MCV (fL)1.2-2.63.9<0.0001
RDW (%)0.190.83-0.830.0379
i-FGF23 (pg/mL)-716.5152.00.80.3305