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Abstract: FR-PO148

Serum Phosphorus and Pill Burden Decreases Among In-Center Hemodialysis (ICHD) Patients Switched to Sucroferric Oxyhydroxide for 12 Months

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Rastogi, Anjay, UCLA, Los Angeles, California, United States
  • Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Parameswaran, Vidhya, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

According to DOPPS data, >75% of ICHD patients (pts) are prescribed phosphate binders (PB) for the control of serum phosphorus (sP); however, >35% of pts have hyperphosphatemia (sP>5.5 mg/dl). The current analysis is a 12-month follow-up on sP and PB pill burden changes in ICHD pts switched from another PB to sucroferric oxyhydroxide (SFO) as part of routine care.

Methods

This retrospective database analysis utilizes de-identified clinical data extracted from electronic health records from a large dialysis organization (LDO; DaVita Inc) and prescription records from the LDO’s pharmacy service. Adult ICHD pts who received 1 year of SFO monotherapy between 5/1/2014 and 9/30/2018 were included in the analysis. Baseline (BL) and follow-up (Q1-Q4) were divided into 3-month intervals. Mixed effects linear regression and Cochran's Q test were used to test for statistical significance.

Results

Pts (n=364) had a mean BMI of 29.8 and dialysis vintage of 52.6 months. 53% of pts were male and most (74%) had a fistula for vascular access. Sevelamer was the most frequently prescribed monotherapy BL PB (64%), followed by calcium acetate (18%) and lanthanum carbonate (7%), and the remaining pts either switched between PB or had combination therapy. Comparisons between BL and SFO follow-up on mineral bone disease markers and PB pill burden are shown in Table. There were consistent improvements in pts achieving sP ≤5.5 mg/dL (increased from 18% at BL to 36.8-38.7% during SFO, p<0.001). Pts were prescribed an average of 9.3 pills/day at BL and 4.3 to 4.9 pills/day during Q1-Q4. Pts who achieved quarterly sP ≤ 5.5 mg/dl had a mean pill burden of 4.7 pills/day and mean sP of 4.72 mg/dL.

Conclusion

ICHD pts from an LDO prescribed to switch PB to SFO as part of routine care for 12 months, experienced significant reductions in sP along with a 47% reduction in PB pills/day and increase in the % of pts with sP ≤5.5 mg/dl.

 BLQ1Q2Q3Q4p-value
PB pill burden (pills/day)9.34.3**4.7**4.8**4.9**<0.001
Serum phosphorus (mg/dL)6.776.13**6.07**6.08**6.13**<0.001
Patients with sP ≤ 5.5 mg/dL (%)18.436.8**38.7**38.5**38.7**<0.001
Patients with sP ≤ 4.5 mg/dL (%)3.611.5*11.8*14.3**12.4*<0.001
Serum calcium (mg/dL)9.08.979.09.08.980.47
Intact PTH (pg/mL)622650657*681**712**<0.001

* p<0.05; ** p<0.001

Funding

  • Commercial Support