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Abstract: SA-PO825

The Effect of Ferric Citrate on IV Iron, ESA Utilization, and Laboratory Parameters in Real-World Dialysis Practice

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Rowan, Christopher G, COHRDATA, Santa Monica, California, United States
  • Foote, Bryce, Keryx Biopharmaceuticals, Boston, Massachusetts, United States
  • Acree, Luke S., Keryx Biopharmaceuticals, Boston, Massachusetts, United States
  • Meltzer, Leslie A, Keryx Biopharmaceuticals, Boston, Massachusetts, United States
  • Lewinter, Robin, Keryx Biopharmaceuticals, Boston, Massachusetts, United States

Ferric Citrate (FC) is an iron-based phosphate (P) binder approved for control of serum P in patients (pts) with CKD on dialysis. We retrospectively evaluated changes in healthcare resource utilization (HRU) and laboratory parameters before and after FC initiation in typical dialysis practice.


FC users were identified between 1/2015-7/2016 from a large U.S. dialysis provider. HRU and lab data were ascertained for continuous FC users in 4 sequential periods (1 pre and 3 post-FC initiation; 3 months each). We determined mean change and mean % change for each post-FC period vs. pre-FC (baseline). Mean change was analyzed using Students t-test for paired data.


2,395 FC initiators were included (mean age 54 years, 50% female, 43% black race). Median dialysis vintage was 3.5 years (mean 4.6 years) and 9% were phosphate binder naive. Mean follow-up for continuous FC users was 104 days. At baseline, P management in these patients was suboptimal as only 25% of pts had P <5.5 mg/dL. P significantly decreased within 1 month (mean change -0.26 mg/dL, P<0.001), and 40% had P <5.5 mg/dL by 6 months. At 3, 6 and 9 months post-FC (compared to pre-FC), we observed small but statistically significant mean increases in hemoglobin, transferrin saturation (TSAT) and ferritin despite decreases in cumulative IV iron and ESA dose (all P<0.05). At 3-6 months post-FC (vs. pre-FC), the mean reduction in cumulative IV iron and ESA administration was -130 mg (P<0.001) and -17,127 IU (P<0.001), respectively. The Figure depicts mean % change for each HRU and lab parameter.


Despite significant reductions in IV iron and ESA utilization, hemoglobin and iron parameters improved within 3 months of FC initiation in pts on dialysis. Additionally, serum P control improved significantly in this patient population.

Figure: HRU and Lab Mean Percent Change


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