ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-OR029

Effect of Ferric Citrate vs. Ferrous Sulfate on Iron, Hemoglobin, and Mineral Metabolism in CKD

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical


  • Womack, Rebecca L., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Panwar, Bhupesh, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Gutierrez, Orlando M., UAB School of Medicine, Birmingham, Alabama, United States

Iron deficiency is common in CKD. Ferric citrate is a novel oral agent for treating iron deficiency anemia in CKD, but little is known about the efficacy of ferric citrate vs. ferrous sulfate (standard of care) in improving iron levels in CKD patients with iron deficiency.


60 patients with stage 3b-4 CKD and iron deficiency (transferrin saturation [TSAT] <30% and ferritin <300 ng/ml) were randomized to ferric citrate (FC; n=30,2 grams tid with meals) or ferrous sulfate (FS; n=30,325 mg po tid) for 12 weeks. Primary outcomes were change in TSAT and ferritin. Secondary outcomes were change in hemoglobin, phosphate, and FGF23.


There were no significant differences in baseline characteristics by treatment arm except FGF23, which was higher in the FS vs. FC arm (Table 1). A total of 25 patients in the FC arm and 26 patients in the FS completed all visits. There were no significant changes in TSAT or phosphate in either arm. Serum ferritin and hemoglobin significantly increased in the FC but not the FS arm (Fig.1). Intact FGF23 decreased 19% in the FC arm (P<0.001) and 3% in the FS arm (P=0.33), and c-terminal FGF23 decreased 15% in the FC arm (P=0.08) and 14% in the FS (P=0.01) arm after 12 weeks. Adverse events were similar in both arms, and mostly involved gastrointestinal complaints.


As compared to FS, treatment with FC resulted in greater increases in ferritin and hemoglobin and a greater decrease in intact FGF23 in CKD patients.


  • Commercial Support