Comparative analysis of the phosphate-binding effects of sucroferric oxyhydroxide, ferric citrate, and lanthanum carbonate

Background: Iron-based phosphate binders are widely used in hemodialysis, to avoid the increased mortality associated with high serum phosphate in dialysis patients. However, comparative studies on the effects of phosphate binders are currently limited. In the present study, a comparative analysis of ferric citrate (FC), sucroferric oxyhydroxide (SF), and lanthanum carbonate (LC) was performed to assess their primary phosphate-binding and secondary iron uptake capacities. Methods: Patients on maintenance hemodialysis visit our group clinics regularly. The FC, SF, and LC groups comprised 101, 82, and 126 patients, respectively. Subjects were observed from December 2015 to April 2016 (5 months). Serum phosphate levels and other markers were measured in the three medication groups, and changes in phosphate levels and other clinical markers were compared. A drug treatment was considered to be effective if the serum phosphate levels of the patient decreased from baseline in each of the drugs. We evaluated the phosphate-binding capacity compared with each drug using a mixed effect model, for adjusted repeated measured analysis. Results: SF showed higher phosphate-binding capacity than FC and LC. FC, SF, and LC showed no significant difference in phosphate-binding capacity in the adjusted mixed effect model. However, patients in the FC group exhibited iron accumulation. Conclusion: Sucroferric oxyhydroxide possesses better phosphate-binding efficacies than ferric citrate and lanthanum carbonate. In addition, ferric citrate showed a strong iron-cumulative effect.