Abstract: PO0377
Changes in Serum Phosphorus Among Patients Who Switch from Sevelamer Carbonate to Sucroferric Oxyhydroxide or Other Phosphate Binders After Persistent Hyperphosphatemia
Session Information
- Biochemical Aspects of Mineral and Bone Disease
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Parameswaran, Vidhya, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Anger, Michael S., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
- Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
Background
Despite being prescribed phosphate binders (PB), many HD patients have persistent hyperphosphatemia. The current analysis examines serum phosphorus (sP) and pill burden changes among patients who have 3 months of sP > 5.5 mg/dl despite prescription of sevelamer carbonate (SC) and switched to (1) sucroferric oxyhydroxide (SO) monotherapy, or (2) Non-SO binders [Calcium Acetate, Lanthanum Carbonate, or Ferric Citrate] monotherapy or added one of these PBs to SC therapy.
Methods
All deidentified clinical and prescription data were extracted retrospectively from the Fresenius Kidney Care database. Follow-up was divided into quarters (Q1-Q4) to determine mean sP and PB pills/day. We applied Propensity Score Matching (PSM), Coarsened Exact Matching (CEM), and Inverse Probability of Treatment Weighting (IPTW) to address potential confounding/selection bias. PSM and CEM were used to match patients using overall PSM or agreement with each variable (CEM), and IPTW used weights on all patients.
Results
We identified 1,076 SC patients with baseline hyperphosphatemia who switched to SO (319 patients) and Non-SO (757 patients) PB therapy. Results from IPTW method that allowed retention of the entire sample size (n=1,076) are presented in Table 1. Application of CEM and PSM methods identified 197 and 257 matches for SO patients, respectively and noted results comparable to IPTW.
Conclusion
In a retrospective database analysis of HD patients with persistent hyperphosphatemia despite being prescribed SC, patients switched to SO had a mean sP decrease of 1.1 mg/dL compared to 0.79 mg/dL decrease among patients prescribed non-SO PBs. The PB pills/day decreased by 6.3 for SO-treated and 2.2 for Non-SO-treated patients.
Table 1
| Group | -Q1 | Q1 | Q2 | Q3 | Q4 | P | |
| Serum phosphorus, mg/dL | SO | 7.05 | 6.48 | 6.24 | 6.1 | 5.95 | <0.001 |
| Non-SO | 7.04 | 6.59 | 6.33 | 6,38 | 6.25 | ||
| Phosphate binder pills/day | SO | 10.9 | 4.2 | 4.3 | 4.4 | 4.6 | <0.001 |
| Non-SO | 10.8 | 8.7 | 8.6 | 8.6 | 8.6 | ||
| Serum calcium, mg/dL | SO | 9.2 | 9.1 | 9 | 9 | 9.1 | 0.6 |
| Non-SO | 9.2 | 9.2 | 9.1 | 9.1 | 9.1 | ||
| iPTH, pg/mL | SO | 501 | 508 | 534 | 531 | 535 | 0.5 |
| Non-SO | 489 | 520 | 532 | 546 | 505 |
SO - 319 patients, Non-SO - 757 patients
Funding
- Commercial Support – Fresenius Medical Care Renal Therapies Group