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Clinical experience with the use of ferric citrate as a phosphate binder in pediatric dialysis patients

Mark R Hanudel1, Marciana Laster2, Georgina Ramos2

  • 1Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA, 90095-1752, USA. mhanudel@mednet.ucla.edu.

Pediatric Nephrology (Berlin, Germany)
|June 30, 2018
PubMed

Insights

Ferric citrate effectively lowered phosphate and improved iron levels in pediatric dialysis patients. This study suggests its potential for treating both conditions concurrently in this population.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Clinical Trials

Background:

  • Ferric citrate, an iron-based phosphate binder, is approved for adults with chronic kidney disease (CKD).
  • Its efficacy and safety in pediatric dialysis patients have not been previously described.
  • Hyperphosphatemia and iron deficiency are common complications in pediatric CKD.

Purpose of the Study:

  • To evaluate the effect of ferric citrate on phosphate levels and iron status in pediatric dialysis patients.
  • To assess the feasibility of using ferric citrate as a concurrent treatment for hyperphosphatemia and iron deficiency in this population.

Main Methods:

  • Retrospective analysis of 11 pediatric dialysis patients (ages 4-17) treated with ferric citrate from 2015-2017.
  • Comparison of time-averaged laboratory values before and after ferric citrate initiation.
  • Statistical analysis using the Wilcoxon signed-rank test.

Main Results:

  • Ferric citrate treatment significantly decreased serum phosphate levels (6.5 to 5.2 mg/dL, p=0.014).
  • Phosphate SDS also decreased significantly (2.3 to 0.9, p=0.019).
  • Transferrin saturation increased (26% to 34%, p=0.049), and ferritin levels showed an upward trend (107 to 230 ng/mL, p=0.074).
  • Hematocrit levels were maintained during treatment.

Conclusions:

  • Ferric citrate may effectively manage both hyperphosphatemia and iron deficiency in pediatric dialysis patients.
  • Larger studies are warranted to confirm the safety and efficacy of ferric citrate in pediatric CKD.
  • This agent offers a potential dual-action therapeutic option for this vulnerable population.
Abstract

Keywords:
CKD-MBDDialysisFerric citrateIron deficiencyPediatricPhosphate

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