Abstract: SA-PO969

Can Ferric Citrate Lead to Iron Overload in Peritoneal Dialysis Patients?

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Basdeo, Luke M, Mayo Clinic Florida, Jacksonville, Florida, United States
  • Govani, Maulik C., Mayo Clinic Florida, Jacksonville, Florida, United States
  • Aslam, Nabeel, Mayo Clinic Florida, Jacksonville, Florida, United States
Background

Ferric citrate (FC), a novel oral phosphorus binder, is FDA approved for treatment of hyperphosphatemia in patients receiving dialysis. FC binds to dietary phosphate in GI tract producing ferric phosphate and is excreted in feces. However, small quantity of iron is systemically absorbed. There is limited data about the safety of ferric citrate among peritoneal dialysis (PD) patients. Iron overload with FC in PD patients has not been previously reported. We present a series of three PD patients who developed iron overload while receiving FC.

Methods

Patient 1- 65-years old man with ESRD due to IgA nephropathy, status post failed kidney transplant, on CCPD for 3 years with adequate clearance, started on ferric citrate in 1/2016, dose adjusted to 3 tablets tid with meals and 1 with snack; max total dose of 11 tablets/day resulting in acceptable phosphorus control. No IV iron or transfusion during subsequent 12 months. Iron studies summarized in table. FC discontinued at 12 months. Hematology work up consistent with acquired hemosiderosis.
Patient 2-51-years old woman with ESRD due to systemic sclerosis, on CCPD for 7 years with good clearance, started on ferric citrate in 1/2016, dose titrated up to maximum of 12 tabs/day with good phosphorus control. No IV iron or blood transfusion during the subsequent 12 months. Iron studies summarized in table. FC discontinued at 12 months.
Patient 3-72-years old man with ESRD due to AL amyloidosis, on CCPD for 1.5 years with adequate clearance, started on ferric citrate in 10/2016, dose titrated up to max of 11 tab/day with acceptable phos control. No IV iron or transfusion after FC initiation. Iron studies summarized in table. FC discontinued at 6 months

Conclusion

PD patients may be more prone to developing iron overload with the use of ferric citrate. This may be due to less iron loses in PD patients as compared to HD patients. These cases highlight the importance of close monitoring of iron studies in PD patients while receiving ferric citrate as phosphate binder. Further studies are needed to assess the safety of maximum approved dose of ferric citrate among PD patients.

Iron Studies
 Prior to StartPrior to Start3 Months3 Months6 Months6 Months9 Months9 Months12 Months12 Months
 Ferritin%SatFerritin%SatFerritin%SatFerritin%SatFerritin%Sat
Patient1475242998n/a216151202859402377
Patient255317123747148644254433197276
Patient3118392663494365    

Funding

  • Clinical Revenue Support