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. 2023 Feb;55(2):377-387.
doi: 10.1007/s11255-022-03327-w. Epub 2022 Aug 11.

A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care

Connie M Rhee  1 , Meijiao Zhou  2 , Rachael Woznick  3 , Claudy Mullon  2 , Michael S Anger  2 , Linda H Ficociello  4
Affiliations

A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care

Connie M Rhee et al. Int Urol Nephrol. 2023 Feb.

Abstract

Objective: Despite the growing number of elderly hemodialysis patients, the influence of age on nutritional parameters, serum phosphorus (sP), and use of phosphate-binder (PB) medications has not been well characterized. We aimed to describe age-related differences in patient characteristics in a large, real-world cohort of maintenance hemodialysis patients, and to examine the impact of age on sP management with sucroferric oxyhydroxide (SO).

Methods: We retrospectively analyzed de-identified data from 2017 adult, in-center hemodialysis patients who switched from another PB to SO monotherapy as part of routine clinical care. Changes in baseline PB pill burden, sP levels, and nutritional and dialytic clearance parameters were assessed across varying age groups through 6 months.

Results: At baseline, older patients had lower mean sP, serum albumin, and pre-dialysis weights compared with younger patients. Prescription of SO was associated with a 62% increase in the proportion of patients achieving sP ≤ 5.5 mg/dl and a 42% reduction in daily pill burden. The proportion of patients achieving sP ≤ 5.5 mg/dl after transitioning to SO increased by 113, 96, 68, 77, 61, 37 and 40% among those aged 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥ 80 years, respectively.

Conclusions: Older patients had worse nutritional parameters, lower pill burden, and lower sP at baseline versus younger counterparts. Prescription of SO was associated with improved sP control and reduced pill burden across all ages.

Keywords: Age; Hemodialysis; Phosphate binder; Phosphorus; Pill burden; Sucroferric oxyhydroxide.

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Conflict of interest statement

MZ, RW, CM, MSA, and LHF are employees of Fresenius Medical Care. CM and MSA own stock in Fresenius Medical Care AG & Co. KGaA. CMR has received honoraria and/or support from Ardelyx, AstraZeneca, Dexcom Inc., Fresenius, Nutricia, Reata, and Roche.

Figures

Fig. 1
Fig. 1
Etiology of kidney failure by age group. aIncludes transplant complications, secondary glomerulonephritis/vasculitis, and other/unknown causes
Fig. 2
Fig. 2
Change in percentage of patients with sP ≤ 5.5 mg/dl from baseline to Q1 (3 months) and Q2 (6 months) after switch to SO by age group. aP < 0.05 vs. baseline; bP < 0.01 vs. baseline; cP < 0.001 vs. baseline. PB phosphate binder, SO sucroferric oxyhydroxide
Fig. 3
Fig. 3
Mean number of PB pills/day at baseline and quarterly after SO switch. The prescription of SO was associated with significant reductions in the mean PB pill burden across all age groups (P < 0.001 vs. baseline at all time points) in both the overall population (left) and among those who achieved sP ≤ 5.5 mg/dl (right)
See this image and copyright information in PMC

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