Serum Phosphorus and Pill Burden Among Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide: One-Year Follow-Up on a Contemporary Cohort

Figures & data

Table 1 Patient Characteristics at Baseline

Demographic Characteristics	2018 Cohort (N = 1792)
Age (years), median (IQR)	57.0 (17.0)
Dialysis vintage (months), median (IQR)	33.9 (52.0)
Pre-dialysis body mass index (kg/m^2), median (IQR)	30.4 (10.6)
Female, n (%)	715 (39.9%)
Race, n (%)^a
White	911 (50.8%)
Black/African American	756 (42.2%)
Other	70 (3.9%)
Unknown	55 (3.1%)
Hispanic/Latino, n (%)^a	266 (14.8%)
Primary cause of renal failure, n (%)
Diabetes mellitus	850 (47.4%)
Hypertension	575 (32.1%)
Glomerulonephritis	123 (6.9%)
Polycystic kidney	42 (2.3%)
Other	201 (11.2%)
Unknown	1 (0.1%)
Diabetes mellitus, n (%)	1035 (57.8%)
Congestive heart failure, n (%)	331 (18.5%)
PB at baseline, n (%)
Sevelamer	841 (46.9%)
Calcium acetate	646 (36.0%)
Lanthanum carbonate	54 (3.0%)
Ferric citrate	115 (6.4%)
Switch among binders^b	136 (7.6%)

Notes: ^aRace/ethnicity was self-reported. ^bAmong 136 patients, the most frequently used phosphate binders were sevelamer (44.9%; n = 61), calcium acetate (37.5%; n = 51), ferric citrate (14.0%; n = 19), and lanthanum carbonate (3.7%; n = 5).

Abbreviations: IQR, interquartile range; PB, phosphate binder.

Table 2 Comparison of Changes in Clinical Parameters and CKD-MBD Medication Use

Parameter	Baseline	Follow-Up				P value
	−Q1; ref	Q1	Q2	Q3	Q4
CKD-MBD biochemical markers
sP (mg/dl)	6.38 (0.03)	6.10 (0.03)^c	5.88 (0.03)^c	5.88 (0.03)^c	5.93 (0.03)^c	<0.0001
sP ≤5.5 mg/dl (%)	27.0	37.8^c	45.1^c	44.7^c	44.0^c	<0.0001
sP ≤4.5 mg/dl (%)	8.4	12.7^c	16.8^c	17.4^c	17.0^c	<0.0001
Corrected calcium (mg/dl)	9.64 (0.01)	9.61 (0.01)^a	9.58 (0.01)^c	9.53 (0.01)^c	9.52 (0.01)^c	<0.0001
iPTH (pg/mL)	564 (10)	560 (10)	558 (10)	545 (10)^a	528 (10)^c	<0.0001
CKD-MBD medications
PB pills/day	7.7 (0.05)	4.4 (0.05)^c	4.6 (0.05)^c	4.8 (0.05)^c	4.9 (0.05)^c	<0.0001
PB pills/day among in-range patients	7.1 (0.09)	4.3 (0.08)^c	4.4 (0.07)^c	4.6 (0.07)^c	4.6 (0.07)^c	<0.0001
Total calcimimetics use (%)	39.8	43.9^c	47.0^c	48.4^c	48.8^c	<0.0001
Cinacalcet use (%)	37.3	38.8^a	40.1^a	39.1	37.8	0.008
Home cinacalcet dose (mg/day)	52.4 (1.4)	53.5 (1.4)^a	55.4 (1.4)^c	57.9 (1.4)^c	58.4 (1.4)^c	<0.0001
In-center cinacalcet dose (mg/administration)	51.9 (2.0)	58.9 (2.0)^c	69.4 (2.0)^c	75.6 (1.9)^c	83.0 (1.9)^c	<0.0001
Etelcalcetide use (%)	5.4	7.7^c	10.1^c	12.1^c	13.6^c	<0.0001
Etelcalcetide dose (mcg/administration)	4.4 (0.21)	5.5 (0.19)^c	6.3 (0.19)^c	6.8 (0.18)^c	7.2 (0.18)^c	<0.0001
Total vitamin D use (%)	84.9	84.7	86.3	86.6^a	88.1^b	<0.0001
IV active vitamin D use (%)	23.4	23.4	23.8	24.7^a	25.2^a	0.001
IV doxercalciferol dose (mcg/week)	11.4 (0.3)	11.4 (0.3)	11.5 (0.3)	11.9 (0.3)^a	12.2 (0.3)^b	0.001
Oral active vitamin D use (%)	63.9	62.9	64.0	63.8	64.5	0.32
Oral calcitriol dose (mcg/day)	0.90 (0.02)	0.91 (0.02)	0.94 (0.02)^b	0.98 (0.02)^c	1.01 (0.02)^c	<0.0001
Nutritional and clearance parameters
Serum albumin (g/dl)	3.89 (0.01)	3.90 (0.01)^c	3.90 (0.01)^c	3.89 (0.01)	3.88 (0.01)	<0.0001
Pre-dialysis weight (kg)	91.5 (0.6)	91.7 (0.6)^c	91.7 (0.6)^c	91.8 (0.6)^c	91.5 (0.6)	<0.0001
Equilibrated nPCR (g/kg/day)	0.95 (0.005)	0.96 (0.005)	0.95 (0.005)	0.94 (0.005)^b	0.94 (0.005)^c	<0.0001
Equilibrated Kt/V	1.46 (0.01)	1.47 (0.01)	1.47 (0.01)^a	1.47 (0.01)	1.46 (0.01)	0.05

Notes: Unless specified, values are presented as least-squares mean (standard error). P values compare summary estimates across time with −Q1 as the reference. Overall P values were calculated using linear mixed-effects regression (continuous variables) or Cochran’s Q test (categorical variables). ^aP < 0.05; ^bP < 0.001; ^cP < 0.0001 (vs baseline).

Abbreviations: CKD, chronic kidney disease; iPTH, serum intact parathyroid hormone; IV, intravenous; MBD, mineral bone disorder; nPCR, normalized protein catabolic rate; PB, phosphate binder; sP, serum phosphorus.

Figure 1 Monthly distribution of patients stratified by sP level.

Abbreviations: PB, phosphate binder; SO, sucroferric oxyhydroxide; sP, serum phosphorus.

Figure 2 Percentage of patients achieving sP ≤5.5 mg/dl stratified by baseline PB type: (A) Sevelamer → SO, (B) Calcium acetate → SO, (C) Lanthanum carbonate → SO, (D) Ferric citrate → SO.

Abbreviations: PB, phosphate binder; SO, sucroferric oxyhydroxide; sP, serum phosphorus.

Table 3 Comparison of Changes in Anemia and Iron Indices and in Anemia Therapies

Parameter	Baseline	Follow-Up				P value
	−Q1; ref	Q1	Q2	Q3	Q4
Anemia and iron indices
Ferritin (ng/mL)	1009 (12)	1042 (12)^b	1094 (12)^c	1114 (12)^c	1138 (12)^c	<0.0001
TSAT (%)	33.2 (0.2)	34.8 (0.2)^c	35.7 (0.2)^c	35.4 (0.2)^c	35.4 (0.2)^c	<0.0001
Hemoglobin (g/dl)	10.91 (0.02)	10.96 (0.02)^c	10.92 (0.02)	10.93 (0.02)	10.94 (0.02)^a	<0.0001
Anti-anemia therapy
IV iron sucrose use (%)	77.7	77.2	73.4^b	71.2^c	69.4^c	<0.0001
IV ESA use (%)	85.6	86.2	84.7	83.4^a	83.3^a	<0.0001

Notes: Unless specified, values are presented as least-squares mean (standard error). P values compare summary estimates across time with −Q1 as the reference. Overall P values were calculated using linear mixed-effects regression (continuous variables) or Cochran’s Q test (categorical variables). ^aP < 0.05; ^bP < 0.001; ^cP < 0.0001 (vs baseline).

Abbreviations: ESA, erythropoiesis-stimulating agent; IV, intravenous; TSAT, transferrin saturation.

Figure 3 Observations in the 2014 and 2018 cohorts: (A) Baseline PB before switch to SO, (B) Proportion of patients achieving sP ≤5.5 mg/dl, (C) Mean serum phosphorus, and (D) Mean PB pill burden. ^aP < 0.0001 vs baseline.

Abbreviations: PB, phosphate binder; SO, sucroferric oxyhydroxide; sP, serum phosphorus.