Abstract: TH-PO785

Changes in Serum Phosphorus, Pill Burden, and Medication Possession Ratio among Chronic Hemodialysis Patients Who Converted to Sucroferric Oxyhydroxide as Part of Routine Care

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Gray, Kathryn S., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Ficociello, Linda H., Fresenius Medical Care - North America, Waltham, Massachusetts, United States
  • Hunt, Abigail, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Mullon, Claudy, Fresenius Medical Care - North America, Waltham, Massachusetts, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background

The large pill burden associated with many phosphate binders (PB) may decrease adherence to PB therapy. The current analysis examines the changes in serum phosphorus, PB pills/day, and medication possession ratio (MPR; estimate of adherence) among patients who converted from a baseline PB to sucroferric oxyhydroxide (SO) as part of routine care.

Methods

Patients eligible for analysis were ≥18 years, received chronic hemodialysis at a large dialysis organization (LDO), and received benefits through the LDO’s pharmacy program. Patients converting to SO use were those who had supply of another PB, received a first prescription fill for SO as part of routine care, and subsequently did not refill a non-SO PB. Baseline (BL) was considered as the 6-month period leading up to first SO fill and SO follow-up (SO-F) the 6-month period following the first SO fill. Patients were censored from the analysis upon loss to follow-up, dialysis modality change, discontinuation of SO, or fill of a prescription for another PB after SO initiation. MPR is the proportion of time that a patient had enough medicine to take as prescribed and was assessed among patients not enrolled in the LDO pharmacy automated refill management service.

Results

There were 490 patients who converted to SO. The majority of patients (66%) were using sevelamer at time of SO initiation, followed by calcium acetate (19%). There was an improvement in serum phosphorus (sP): mean (95% CI) sP was 6.9 mg/dL (6.8, 7.1) at BL and 6.8 mg/dL (6.6, 6.9) at SO-F (P=0.02). The percent of patients achieving sP ≤5.5 mg/dL increased from 21.7% at BL to 28.8% at SO-F (P<0.001).The mean total PB pill burden at BL was 10.8 pills/day and this decreased by 49% to 5.5 pills/day at SO-F (P<0.001). Among patients who were not using the LDO refill management service (n=30), mean total PB MPR was 0.68 at BL and 0.80 at SO-F.

Conclusion

In a cohort of hemodialysis patients prescribed SO through a renal pharmacy service as part of routine care, improvements in sP were observed along with a 49% decrease in prescribed PB pills/day and, among the subset of patients not using the LDO pharmacy refill management service, an increase in MPR from 0.68 to 0.80.

Funding

  • Commercial Support