Effects of Oral Ferric Citrate or Intravenous Iron Supplement on Biomarkers of Chronic Kidney Disease-Mineral Bone Disorder and Cardiovascular Events in Patients Undergoing Long-Term Hemodialysis

Yueh-Chu Sio ； Che-Yu Lin ； Guo-Qiang Zeng ； Chia-Te Liao ； Jing-Yi Chen ； Chih-Chin Kao ； Chun-Che Shih ； Mai-Szu Wu ； Hsin-Ying Lu ； Yen-Chung Lin

《Acta Nephrologica》 37卷1期 (2023/03) Pp. 34-48

https://doi.org/10.6221/AN.202303_37(1).0004

摘要

BACKGROUND: Ferric citrate, an iron-based phosphate binder used to decrease phosphate absorption in hemodialysis (HD) patients. The effect on biomarkers of chronic kidney disease-mineral bone disorder (CKD-MBD) is undetermined. METHODS: We enrolled 41 HD patients at Taipei Medical University Hospital. Nineteen of them were in the study group who were using oral ferric citrate and the others using IV iron supplements regularly as control from January 2017 to January 2018. We measured intact fibroblast growth factor-23 (FGF- 23), soluble klotho, and hepcidin at 3, 6, and 9 months, and recorded their cardiovascular events as the outcomes. RESULTS: The mean age was 61.73 ± 8.18 years old. Intact FGF-23 was decreased between the 3rd and 6th months in the study group (P = 0.02). In addition, hepcidin was increased between the 3rd and 9th months in the study group (P = 0.03). After we adjusted age, gender, diabetes, and serum phosphate levels, only intact FGF-23 and ferritin levels were significantly decreased in the study group (P < 0.01 and P = 0.04 respectively). The iron profile and serum phosphate, calcium, or intact parathyroid hormone levels of the two groups were similar. CONCLUSIONS: Oral ferric citrate users in HD patients had a lower intact FGF-23 and ferritin level than those with IV iron supplements. Further investigations are warranted for the long-term benefits of oral ferric citrate on CKD-MBD.

關鍵字

biomarkers ； chronic kidney disease-mineral bone disorder ； end stage renal disease ； fibroblast growth factor ； iron