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DOI: 10.1055/s-0036-1571391
Neue eisenhaltige Phosphatbinder – Erweiterung des Behandlungsspektrums bei Nierenkranken
New iron-containing phosphate binders – Broadening the treatment options for patients with CKDPublication History
Publication Date:
25 January 2016 (online)
Sowohl Eisenzitrat als auch Sucroferric Oxyhdroxyd sind wirksame, sichere und verträgliche Phosphatbinder. Beide Substanzen sind den bislang verfügbaren Phosphatbindern nicht unterlegen und erweitern somit in positiver Weise die Therapiemöglichkeiten der Hyperphosphatämie. Eisenzitrat wirkt zudem als orales Eisensupplement, da der Zitratanteil offenbar selbst bei fortgeschrittener Niereninsuffizienz eine signifikante intestinale Eisenaufnahme ermöglicht. Hier mag es sich um einen relevanten „Zusatznutzen“ handeln, insbesondere bei Patienten im unmittelbaren Prädialysestadium oder bei Peritonealdialysepatienten. Allerdings ist noch nicht abschließend geklärt, inwieweit bei langfristiger Einnahme eine unerwünschte Eisenakkumulation auszuschließen ist. Dazu muss parallel zur Behandlung mit Eisenzitrat zwingend auf die Vermeidung oraler Aluminiumzufuhr geachtet werden. Da bei Sucroferric Oxyhdroxyd das Eisen in einer Zucker-Stärke-Matrix gebunden ist, kommt es hier zu einer wesentlich geringeren intestinalen Eisenaufnahme, diese Substanz scheint im Endeffekt einen mehr oder weniger neutralen Effekt auf den Eisenstoffwechsel zu besitzen. Der größte „Zusatznutzen“ von Sucroferric Oxyhydroxyd liegt vermutlich bei einer hohen phosphatbindenden Effektivität im Kontext einer geringen Tablettenlast, was insbesondere die Therapieadhärenz positiv beeinflussen sollte.
Both ferric citrate and sucroferric oxyhydroxyde are effective, safe and well-tolerated phosphate binders. Both substances are non-inferior compared to available standard therapy and will thus broaden the armatorium of phosphate lowering treatment options. In addition, ferric citrate may serve as an effective oral iron supplementation, because citrate obviously facilitates intestinal iron uptake even in patients with advanced chronic kidney disease (CKD). This may be regarded as a relevant added value, especially in pre-ESRD stages and in patients on peritoneal dialysis. However, it will have to be excluded that ferric citrate leads to an excessive iron accumulation with long-term use. Further, in the presence of ferric citrate medication, parallel oral aluminum intake must be carefully avoided. In case of sucroferric oxyhydroxyde, the iron is bound in a sugar/starch matrix and thus significantly less available for intestinal absorption. In quintessence, the clinical impact of sucroferric oxyhydroxyde on iron metabolism seems almost neutral. A significant added value of sucroferric oxyhydroxyde is related to its high phosphate-binding capacity in the context of a low pill burden. This fact should positively impact on patient adherence to the treatment.
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Literatur
- 1 Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009; 113: 1-130
- 2 Cannata-Andía JB, Fernández-Martín JL, Locatelli F et al. Use of phosphate-binding agents is associated with a lower risk of mortality. Kidney Int 2013; 84: 998-1008
- 3 Fernández-Martín JL, Martínez-Camblor P, Dionisi MP et al. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant 2015; 30: 1542-1551
- 4 Jamal SA, Vandermeer B, Raggi P et al. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 2013; 382: 1268-1277
- 5 Iida A, Kemmochi Y, Kakimoto K et al. Ferric citrate hydrate, a new phosphate binder, prevents the complications of secondary hyperparathyroidism and vascular calcification. Am J Nephrol 2013; 37: 346-358
- 6 Sinsakul M, Sika M, Koury M et al. Collaborative Study Group. The safety and tolerability of ferric citrate as a phosphate binder in dialysis patients. Nephron Clin Pract 2012; 121
- 7 Yokoyama K, Hirakata H, Akiba T et al. Effect of oral JTT-751 (ferric citrate) on hyperphosphatemia in hemodialysis patients: results of a randomized, double-blind, placebocontrolled trial. Am J Nephrol 2012; 36: 478-487
- 8 Dwyer JP, Sika M, Schulman G et al. Collaborative Study Group. Dose-response and efficacy of ferric citrate to treat hyperphosphatemia in hemodialysis patients: a short-term randomized trial. Am J Kidney Dis 2013; 61: 759-766
- 9 Yokoyama K, Akiba T, Fukagawa M et al. A randomized trial of JTT-751 versus sevelamer hydrochloride in patients on hemodialysis. Nephrol Dial Transplant 2014; 29: 1053-1060
- 10 Lee CT, Wu IW, Chiang SS et al. Effect of oral ferric citrate on serum phosphorus in hemodialysis patients: multicenter, randomized, double-blind, placebo-controlled study. J Nephrol 2015; 28: 105-113
- 11 Lewis JB, Sika M, Koury MJ et al. For the Collaborative Study Group. Ferric citrate controls phosphorus and delivers iron in patients on dialysis. J Am Soc Nephrol 2015; 26: 493-503
- 12 Phan O, Maillard M, Peregaux C et al. PA21, a new iron-based noncalcium phosphate binder, prevents vascular calcification in chronic renal failure rats. J Pharmacol Exp Ther 2013; 346: 281-289
- 13 Wilhelm M, Gaillard S, Rakov V et al. The iron-based phosphate binder PA21 has potent phosphate binding capacity and minimal iron release across a physiological pH range in vitro. Clin Nephrol 2014; 81: 251-258
- 14 Geisser P, Philipp E. PA21: a novel phosphate binder for the treatment of hyperphosphatemia in chronic kidney disease. Clin Nephrol 2010; 74: 4-11
- 15 Wüthrich RP, Chonchol M, Covic A et al. Randomized clinical trial of the iron-based phosphate binder PA21 in hemodialysis patients. Clin J Am Soc Nephrol 2013; 8: 280-289
- 16 Floege J, Covic AC, Ketteler M et al. A phase III study of the efficacy and safety of a novel iron-based phosphate binder in dialysis patients. Kidney Int 2014; 86: 638-647
- 17 Floege J, Covic AC, Ketteler M et al. Long-term effects of the iron-based phosphate binder, sucroferric oxyhydroxide, in dialysis patients. Nephrol Dial Transplant 2015; 30: 1037-1046