Usefulness of Oral Ferric Citrate in Patients With Iron-Deficiency Anemia and Chronic Kidney Disease With or Without Heart Failure.

Abstract

Patients with chronic inflammatory conditions including chronic kidney disease (CKD) and heart failure (HF) are undertreated with iron-deficiency anemia (IDA). Progressive inflammation and reduced iron transport associated with CKD and HF may reduce the efficacy of oral iron therapy. Oral ferric citrate improves anemia markers in CKD, but its effects in patients with CKD and concomitant HF have not been described. Patients with CKD not on dialysis and IDA from a phase 2 and 3 trial were treated with ferric citrate (n = 190) or placebo (n = 188); patients with HF were identified from medical histories. Hemoglobin response was defined as a ≥10.0-g/L increase in hemoglobin. Changes in hemoglobin, transferrin saturation, ferritin, and serum phosphate from baseline to week 12 and the incidence of adverse events potentially related to HF were evaluated. HF was reported in 22% (n = 81) of patients. The proportion of patients with hemoglobin response to ferric citrate treatment did not significantly differ in patients with and without HF (43% vs 49%, respectively; p = 0.47); changes from baseline in hemoglobin, iron parameters, and serum phosphate were similar. Adverse events potentially related to HF were noted more frequently in patients with HF (ferric citrate, 23%; placebo, 17%) versus those without HF (ferric citrate, 12%; placebo, 11%). In conclusion, these results indicate a potential role for ferric citrate in the treatment of IDA in patients with CKD not on dialysis and concomitant HF.

• Authors: Peter A McCullough, Katrin Uhlig, John F Neylan, Pablo E Pergola, Steven Fishbane
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 122 Issue 4 Pg. 683-688 (08 15 2018) ISSN: 1879-1913 [Electronic] United States
• PMID: 29961562 (Publication Type: Clinical Trial, Phase II, Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Ferric Compounds
• ferric citrate
• Ferritins

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency (blood, complications, drug therapy)
• Biomarkers (blood)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Ferric Compounds (administration & dosage)
• Ferritins (blood)
• Follow-Up Studies
• Heart Failure (blood, complications)
• Humans
• Male
• Middle Aged
• Renal Insufficiency, Chronic (blood, complications)
• Treatment Outcome
• Young Adult