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Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide

Authors Cernaro V, Santoro D, Lacquaniti A, Costantino G, Visconti L, Buemi A, Buemi M

Received 25 September 2015

Accepted for publication 11 December 2015

Published 2 February 2016 Volume 2016:9 Pages 11—19


Checked for plagiarism Yes

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Peer reviewers approved by Dr Madhusudan Venkatareddy

Peer reviewer comments 3

Editor who approved publication: Professor Pravin Singhal

Video abstract presented by Dr Valeria Cernaro

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Valeria Cernaro, Domenico Santoro, Antonio Lacquaniti, Giuseppe Costantino, Luca Visconti, Antoine Buemi, Michele Buemi

Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

Abstract: Chronic kidney disease-mineral bone disorder is frequent in patients with renal failure. It is characterized by abnormalities in mineral and bone metabolism with resulting hyperphosphatemia, low serum vitamin D, secondary hyperparathyroidism, altered bone morphology and strength, higher risk of bone fractures, and development of vascular or other soft tissue calcifications. Besides the recommendation to reduce phosphorus dietary intake, many drugs are currently available for the treatment of calcium/phosphate imbalance. Among them, phosphate binders represent a milestone. Calcium-based binders (calcium carbonate, calcium acetate) are effective in lowering serum phosphate, but their use has been associated with an increased risk of hypercalcemia and calcifications. Calcium-free binders (sevelamer hydrochloride, sevelamer carbonate, and lanthanum carbonate) are equally or slightly less effective than calcium-containing compounds. They would not induce an increase in calcium levels but may have relevant side effects, including gastrointestinal symptoms for sevelamer and risk of tissue accumulation for lanthanum. Accordingly, new phosphate binders are under investigation and some of them have already been approved. A promising option is sucroferric oxyhydroxide (Velphoro®, PA21), an iron-based phosphate binder consisting of a mixture of polynuclear iron(III)-oxyhydroxide, sucrose, and starches. The present review is focused on pharmacology, mode of action, and pharmacokinetics of sucroferric oxyhydroxide, with a discussion on comparative efficacy, safety, and tolerability studies of this drug in chronic kidney disease and patient perspectives such as quality of life, satisfaction, and acceptability. Sucroferric oxyhydroxide has proven to be as effective as sevelamer in reducing phosphatemia with a similar safety profile and lower pill burden. Experimental and clinical studies have documented a minimal percentage of iron absorption without inducing toxicity. In conclusion, the overall benefit–risk balance of sucroferric oxyhydroxide is deemed to be positive, and this new drug may therefore represent a good alternative to traditional phosphate binders for the treatment of hyperphosphatemia in dialysis patients.

Keywords: chronic kidney disease-mineral bone disorder, CKD-MBD), iron(III)-oxyhydroxide, phosphate binders, sucroferric oxyhydroxide

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