- Oral ferric citrate increased
hemoglobin levels in patients with chronic kidney disease.
- The treatment was effective in
correcting anemia within 2 weeks of initiation.
- Diarrhea and constipation were the common adverse events but was
in chronic kidney disease (CKD) can be corrected by the oral
route with the use of supplements.
Iron deficiency occurs in more than half of
the population with CKD which accounts for nearly 30 million adults in the
United Sates. If left untreated, the dangerously low levels of iron, can lead
to low red blood cell counts or anemia.
‘Oral ferric citrate boosted hemoglobin levels in anemic patients with chronic kidney disease and the dose had minimal adverse events.’
When someone with CKD have
20 to 50% of normal kidney function, anemia might begin to develop and tends to
worsen as CKD progresses.
Iron is an essential component that produces healthy red blood cells. Iron and oxygen make up hemoglobin, which
is the part of the red blood cells that carries oxygen. Ensuring enough iron in
the body helps correct anemia.
does anemia strike in CKD?
Erythropoietin (EPO), a
hormone produced by the kidneys that prompt the bone marrow to synthesize
red blood cells. In CKD, the kidneys are unable to produce EPO and so the bone
marrow makes fewer red blood cells, causing anemia. The body is deprived of
oxygen when the red blood cell count goes down.
The other common causes of
anemia in people with kidney disease include blood loss from hemodialysis and
low levels of iron, vitamin B12 and folic in the diet. These nutrients are
required for the red blood cells to make hemoglobin, the main oxygen-carrying
protein in the red blood cells.
to treat Anemia in CKD?
The only treatment approved by the
US Food and Drug Administration for iron deficiency are intravenous
formulations of iron. These formulations carry certain risks including
anaphylaxis or allergic reaction. The allergy might be skin rash, nausea, vomiting, difficulty in breathing or shock.
Also, there are
other concerns including, decline in kidney function and
cardiovascular events. The Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT),
which was the only placebo-controlled trial with large sample size, failed to
show an advantage of complete anemia correction with darbepoetin alfa, a synthetic form of erythropoietin which is
administered intravenously or by a subcutaneous injection. But, it failed
to increase the target
hemoglobin value of 13 g/dl, as compared with placebo.
Exposure to intravenous iron, as compared
with oral iron, increased the frequency of serious adverse events, including
cardiovascular events and hospitalization-requiring infections.
Oral Iron Intake treat Anemia in CKD?
The use of oral or
intravenous iron to correct anemia in CKD is an ongoing debate. A study
published the Journal of the American Society of
points out an alternative to intravenous iron.
Glenn Chertow, MD, MPH, Stanford University
School of Medicine and his colleagues conducted a study to test whether an oral
iron formulation called ferric citrate might be a safe and effective
In a double blind clinical
trial, 117 patients
received oral ferric citrate and 115 received placebo. During a 16-week
randomized period, 52.1% of patients receiving ferric citrate achieved a
1.0-g/dl increase in hemoglobin (a reflection of red blood cell counts).
The effect of the treatment was seen as early
as 1-2 weeks after the start of treatment, and the response was durable. There
were some common adverse events including diarrhea and constipation in the
ferric citrate (12.0%) and placebo groups (11.2%).
"Secondary endpoints related to
correction of anemia and lowering of serum phosphate were also reached in
ferric citrate-treated patients. In addition, exploratory endpoints showed
improvements in other parameters of mineral metabolism in ferric
citrate-treated patients," said Dr. Chertow.
In addition to affecting iron levels,
ferric citrate also functions as an intestinal phosphate binder and has been
approved for the treatment of hyperphosphatemia in patients on dialysis.
Dr. Chertow noted that although oral ferric
citrate boosted hemoglobin levels in the study, additional research is needed
to see if the drug prolongs life or improves patients' quality of life.
- Steven Fishbane, Geoffrey A. Block, Lisa Loram, John Neylan, Pablo E. Pergola, Katrin Uhlig and Glenn M. Chertow. "Effects of ferric citrate in patients with non-dialysis-dependent-chronic kidney disease and iron-deficiency anemia." Journal of the American Society of Nephrology (2016). DOI: 10.1681/ASN.2016101053
- Iron therapy for renal anemia: how much needed, how much harmful? - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805051/)
- Iron and Chronic Kidney Disease: What you need to know - (https://www.kidney.org/sites/default/files/docs/11-10-0284_patbro_irondeficiency.pdf)
- Oral or intravenous iron for anemia correction in chronic kidney disease? - (http://www.kidney-international.org/article/S2157-1716(15)32256-5/pdf)
- Anemia in Chronic Kidney Disease - (https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/anemia)