Abstract: SA-PO0540
Comparative Effects of Ferric Citrate and Sevelamer on Protein-Bound Uremic Toxins in Patients with Nondialysis-Dependent CKD and Hyperphosphatemia: A Randomized Controlled Trial
Session Information
- CKD: Clinical - Therapies, CKM Health, Special Populations, and More
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Jiamjaipaiboon, Wannee, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Susantitaphong, Paweena, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background
Protein-bound uremic toxins (PBUTs), particularly p-cresyl sulfate (PCS) and indoxyl sulfate (IS), are associated with cardiovascular and all-cause mortality. Although Sevelamer has shown potential effects on PBUTs reduction and Ferric citrate may modulate the gut microbiome diversity, evidence remains inconsistent. We therefore compared their impact on PBUTs in pre-dialysis CKD patients with hyperphosphatemia.
Methods
In this multicenter, open-label, randomized study, 75 adults with pre-dialysis CKD and hyperphosphatemia were randomized 1:1 to Ferric citrate (n=37) or Sevelamer (n=38) for 1 month. The primary outcome was the proportion of responders, defined as any decrease in PBUT levels from baseline. Continuous outcomes were log-transformed [ln(x)]. Analyses followed the per-protocol principle. Risk differences were used with a non-inferiority margin of 15%. Secondary analyses included paired t-tests and Welch’s t-tests. Secondary outcomes included eGFR, phosphate, PTH, FGF23, hemoglobin, iron studies, inflammatory and nutrition markers.
Results
P-cresyl sulfate levels did not significantly decrease in either group, and non-inferiority in responder proportions was inconclusive (risk difference −10.3%; 95% CI, −25.5% to 4.8%). For indoxyl sulfate, both groups showed significant within-group reduction (ΔlnIS −0.27 (95% CI −0.43 to −0.11; p=0.001 in Ferric citrate and ΔlnIS −0.32 (95% CI −0.49 to −0.14; p<0.001 in Sevelamer group). Serum phosphate and intact FGF23 levels decreased significantly in both groups (p < 0.001 and p < 0.005, respectively), while eGFR remained stable. Sevelamer resulted in greater reductions in LDL cholesterol and hs-CRP, whereas ferric citrate improved iron indices.
Conclusion
The effect on PCS reduction was inconclusive. However, both agents significantly reduced indoxyl sulfate and intact FGF23. Sevelamer improved lipid and inflammatory profiles, whereas ferric citrate enhanced iron parameters, supporting a personalized approach to phosphate binder selection in CKD.
Acknowledgment
I sincerely thank my advisor, Professor Paweena Susantitaphong, and all co-investigators, collaborators, and staff at King Chulalongkorn Memorial Hospital and Bhumibol Adulyadej Hospital for their support. This study was supported by the Thai Red Cross Society Research Fund. I am grateful to all patients, colleagues, and my family for their encouragement.
Funding
- Government Support – Non-U.S.