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Ther Adv Chronic Dis. 2015 Sep;6(5):252-63. doi: 10.1177/2040622315589934.

Managing hyperphosphatemia in patients with chronic kidney disease on dialysis with ferric citrate: latest evidence and clinical usefulness.

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Department of Nephrology and Hypertension, Barzilai University Medical Center, 2 Hahistadrut St, Ashkelon 78278, Israel.
Division of Nephrology, Baylor College of Medicine, Houston, TX, USA.
Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH, USA.
Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Nephrology and Hypertension, University of Vermont Medical Group, Burlington, VT, USA.


Ferric citrate is a novel phosphate binder that allows the simultaneous treatment of hyperphosphatemia and iron deficiency in patients being treated for end-stage renal disease with hemodialysis (HD). Multiple clinical trials in HD patients have uniformly and consistently demonstrated the efficacy of the drug in controlling hyperphosphatemia with a good safety profile, leading the US Food and Drug Administration in 2014 to approve its use for that indication. A concurrent beneficial effect, while using ferric citrate as a phosphate binder, is its salutary effect in HD patients with iron deficiency being treated with an erythropoietin-stimulating agent (ESA) in restoring iron that becomes available for reversing chronic kidney disease (CKD)-related anemia. Ferric citrate has also been shown in several studies to diminish the need for intravenous iron treatment and to reduce the requirement for ESA. Ferric citrate is thus a preferred phosphate binder that helps resolve CKD-related mineral bone disease and iron-deficiency anemia.


efficacy; ferric citrate; hemodialysis; hyperphosphatemia; iron deficiency; safety

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