Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

Abstract

Background: A database analysis was conducted to assess the effectiveness of sucroferric oxyhydroxide (SO) on lowering serum phosphorus and phosphate binder (PB) pill burden among adult peritoneal dialysis (PD) patients prescribed SO as part of routine care.

Methods: Adult PD patients (n = 258) prescribed SO through a renal pharmacy service were analyzed. Baseline was 3 months before SO prescription. SO-treated follow-up was for 6 months or until either a new PB was prescribed, SO was not refilled, PD modality changed, or patient was discharged. In-range serum phosphorus was defined as ≤5.5 mg/dL.

Results: At baseline, mean serum phosphorus was 6.59 mg/dL with 10 prescribed PB pills/day. The proportion of patients achieving in-range serum phosphorus increased by 72% from baseline to month 6. Prescribed PB pills/day decreased by 57% (10 at baseline to 4.3 at SO follow-up, p < 0.0001). The mean length of SO follow-up was 5.1 months; SO follow-up ended for 38, 27, and 50 patients at months 4, 5, and 6, respectively, due to no further PB fills, and for 10, 11, and 4 patients at months 4, 5, and 6, respectively, due to another PB prescribed. In patients with baseline serum phosphorus >5.5 mg/dL who achieved in-range serum phosphorus during SO follow-up for ≥1 quarter, a notable improvement in serum phosphorus (6.54 to 5.10 mg/dL, p < 0.0001) was observed, and there was a 53% reduction in PB pill burden (9.9 to 4.7, p < 0.0001).

Conclusion: Among PD patients prescribed SO as part of routine care, improvements in serum phosphorus control and >50% reduction in PB pills/day were observed.

Keywords: Chronic kidney disease-mineral bone disorders; Peritoneal Dialysis; Phosphate binders; Phosphorus.

Fig. 1

Baseline PB prescriptions prior to SO initiation. * Combination of sevelamer, calcium acetate, and/or lanthanum carbonate. FKC EHR, Fresenius Kidney Care Electronic Heath Record database; PB, phosphate binder.

Fig. 2

Percent of patients with monthly serum phosphorus ≤ 5.5 mg/dL at baseline and SO follow-up. PB pills/day for patients with in-range serum phosphorus decreased from (9.7, 8.8, and 9.0) at baseline to (3.9, 4.4, 4.2, 4.4, 4.5, and 4.8) at SO follow-up. SO, sucroferric oxyhydroxide; PB, phosphate binder.