Abstract: SA-PO969
Can Ferric Citrate Lead to Iron Overload in Peritoneal Dialysis Patients?
Session Information
- Fellows/Residents Case Reports: ESRD: HD, PD, Transplant
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
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 Start | Prior to Start | 3 Months | 3 Months | 6 Months | 6 Months | 9 Months | 9 Months | 12 Months | 12 Months | |
| Ferritin | %Sat | Ferritin | %Sat | Ferritin | %Sat | Ferritin | %Sat | Ferritin | %Sat | |
| Patient1 | 475 | 24 | 2998 | n/a | 2161 | 51 | 2028 | 59 | 4023 | 77 |
| Patient2 | 553 | 17 | 1237 | 47 | 1486 | 44 | 2544 | 33 | 1972 | 76 |
| Patient3 | 118 | 39 | 266 | 34 | 943 | 65 |
Funding
- Clinical Revenue Support