Clinical Trial Center, Hallym University Hospital, Anyang, Republic of Korea.
Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
Br J Clin Pharmacol. 2021 Feb;87(2):414-426. doi: 10.1111/bcp.14396. Epub 2020 Jun 17.
Phosphate-lowering effects of ferric citrate were reported in several clinical trials, but mostly in small-scale studies. The aim of this meta-analysis was to investigate the efficacy and safety of ferric citrate in controlling hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients.
PubMed, Embase and Cochrane Library were searched for clinical trials that enrolled CKD patients receiving ferric citrate for hyperphosphataemia. Two investigators performed systematic literature search to identify eligible studies, evaluated risk of bias and extracted relevant data.
Sixteen studies were included in the meta-analysis. Phosphate-lowering effects of ferric citrate were greater compared to no active treatment (standardized mean difference [SMD] = -1.15; P < 0.001) and comparable to other phosphate binders (SMD = 0.03; P = 0.61). Calcium concentrations post ferric citrate treatment did not differ compared to no active treatment (SMD = 0.15; P = 0.21) but were significantly lower compared to other phosphate binders (SMD = -0.14; P = 0.01). These led to significant reductions in calcium-phosphorus product with ferric citrate versus no active control (SMD = -1.02; P < 0.001) but no difference versus active control (SMD = -0.01; P = 0.93). Intact parathyroid hormone showed no substantial between-group difference in both comparison against no active and active controls. Ferric citrate improved iron stores and anaemia parameters, but increased risk of diarrhoea, abdominal pain and discoloured faeces.
Ferric citrate was effective in lowering phosphorus and phosphorus-calcium product versus no active treatment and had comparable effects versus other phosphate binders. Calcium levels were significantly lower with ferric citrate than with other phosphate-lowering treatment. Ferric citrate had additive effects on iron repletion and anaemia control and was associated with mostly gastrointestinal side effects.
柠檬酸铁在几项临床试验中被报道具有降低血磷的作用，但大多数都是在小规模研究中。本荟萃分析的目的是调查柠檬酸铁在控制慢性肾脏病（CKD）患者高磷血症和缺铁性贫血中的疗效和安全性。
检索了 PubMed、Embase 和 Cochrane Library 中纳入接受柠檬酸铁治疗高磷血症的 CKD 患者的临床试验。两名研究者进行了系统文献检索，以确定合格的研究，评估了偏倚风险并提取了相关数据。
共有 16 项研究纳入荟萃分析。与无活性治疗相比，柠檬酸铁降低血磷的效果更大（标准化均数差 [SMD] = -1.15；P < 0.001），与其他磷结合剂相当（SMD = 0.03；P = 0.61）。与无活性治疗相比，柠檬酸铁治疗后钙浓度无差异（SMD = 0.15；P = 0.21），但与其他磷结合剂相比显著降低（SMD = -0.14；P = 0.01）。与无活性对照相比，柠檬酸铁治疗导致钙磷乘积显著降低（SMD = -1.02；P < 0.001），但与活性对照相比无差异（SMD = -0.01；P = 0.93）。与无活性和活性对照相比，全段甲状旁腺激素在两组之间均无明显的组间差异。柠檬酸铁改善了铁储存和贫血参数，但增加了腹泻、腹痛和粪便变色的风险。
柠檬酸铁在降低磷和磷钙乘积方面与无活性治疗相比是有效的，并且与其他磷结合剂相比具有相当的效果。与其他降低血磷的治疗方法相比，柠檬酸铁治疗后钙水平显著降低。柠檬酸铁对铁补充和贫血控制具有附加作用，并与大多数胃肠道副作用相关。
