Koiwa Fumihiko, Yokoyama Keitaro, Fukagawa Masafumi, Akizawa Tadao
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Clin Kidney J. 2018 Sep 19;12(2):294-299. doi: 10.1093/ckj/sfy077. eCollection 2019 Apr.
A sub-analysis of a Phase III study was conducted to identify factors that might predict increased ferritin levels during long-term sucroferric oxyhydroxide (SO) treatment in hemodialysis patients.
The open-label, multicenter, Phase III study assessed the efficacy and safety of SO 750-3000 mg/day for 52 weeks in Japanese patients with chronic renal failure and hyperphosphatemia. A total of 125 of 161 patients from the Phase III trial, and who had data for ferritin levels after 28 weeks of SO treatment, were evaluated.
Baseline ferritin was the strongest contributor (P < 0.0001) to ferritin increases during SO treatment. By Week 28, there were significant differences (P < 0.05/3) in ferritin increases between patients with higher [quartile 4 (Q4)] versus lower (Q1, Q2 and Q3) baseline ferritin. An erythropoiesis-stimulating agent dosage reduction was observed in patients with the lowest baseline ferritin level (Q1), and only slight reductions were noted in the other patient subsets. SO dosages administered to patients in baseline ferritin quartiles Q2, Q3 and Q4 were comparable throughout the study with slight fluctuations. SO dosages in Q1 were considerably lower than those in the other quartiles.
In summary, of the baseline variables found to predict increased ferritin, and changes in iron-related parameters, during SO treatment in Japanese chronic kidney disease patients undergoing hemodialysis, baseline ferritin was the most relevant variable.
开展了一项III期研究的亚分析,以确定在血液透析患者长期接受羟基氧化铁蔗糖(SO)治疗期间可能预测铁蛋白水平升高的因素。
这项开放标签、多中心的III期研究评估了日本慢性肾衰竭和高磷血症患者每天服用750 - 3000毫克SO,持续52周的疗效和安全性。对III期试验中的161名患者中的125名进行了评估,这些患者在接受SO治疗28周后有铁蛋白水平数据。
基线铁蛋白是SO治疗期间铁蛋白升高的最主要因素(P < 0.0001)。到第28周时,基线铁蛋白较高[四分位数4(Q4)]的患者与较低(Q1、Q2和Q3)的患者相比,铁蛋白升高存在显著差异(P < 0.05/3)。基线铁蛋白水平最低(Q1)的患者促红细胞生成素刺激剂剂量降低,而其他患者亚组仅略有降低。在整个研究过程中,基线铁蛋白四分位数Q2、Q3和Q4患者的SO剂量相当,有轻微波动。Q1组的SO剂量明显低于其他四分位数组。
总之,在接受血液透析的日本慢性肾病患者SO治疗期间,在预测铁蛋白升高及铁相关参数变化的基线变量中,基线铁蛋白是最相关的变量。