The First Affiliated Hospital, Hengyang Medical School, Department of Nephrology, University of South China, Hengyang, China, Hengyang, China.
Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, China.
Ren Fail. 2022 Dec;44(1):1112-1122. doi: 10.1080/0886022X.2022.2094273.
Hyperphosphatemia and anemia, which are common complications of chronic kidney disease (CKD), can independently contribute to cardiovascular events. Several previous studies have found that the iron-based phosphate binder, ferric citrate (FC), could be beneficial to both hyperphosphatemia and anemia.
Relevant literature from PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CCRCT) and MEDLINE databases were searched up to 21 February 2022, in order to conduct a meta-analysis to investigate the efficacy, safety and economic benefits of ferric citrate treatment in CKD patients with hyperphosphatemia and anemia. The meta-analysis was conducted independently by two reviewers using the RevMan software (version 5.3).
In total, this study included 16 randomized clinical trials (RCT) involving 1754 participants. The meta-analysis showed that ferric citrate could significantly reduce the serum phosphorus in CKD patients compared to the placebo control groups (MD -1.76 mg/dL, 95% CI (-2.78, -0.75); = 0.0007). In contrast, the difference between ferric citrate treatment and active controls, such as non-iron-based phosphate binders, sevelamer, calcium carbonate, lanthanum carbonate and sodium ferrous citrate, was not statistically significant (MD - 0.09 mg/dL, 95% CI (-0.35, 0.17); = 0.51). However, ferric citrate could effectively improve hemoglobin levels when compared to the active drug (MD 0.43 g/dL, 95% CI (0.04, 0.82); = 0.03) and placebo groups (MD 0.39 g/dL, 95% CI (0.04, 0.73); = 0.03). According to eight studies, ferric citrate was found to be cost-effective treatment in comparison to control drugs. Most of the adverse events (AE) following ferric citrate treatment were mild at most.
Collectively, our review suggests that iron-based phosphate binder, ferric citrate is an effective and safe treatment option for CKD patients with hyperphosphatemia and anemia. More importantly, this alternative treatment may also less expensive. Nevertheless, more scientific studies are warranted to validate our findings.
高磷血症和贫血是慢性肾脏病（CKD）的常见并发症，它们都可独立导致心血管事件。先前的几项研究发现，铁基磷酸盐结合剂柠檬酸铁（FC）可能对高磷血症和贫血都有益。
检索了 PUBMED、EMBASE、Cochrane 对照试验中心注册库（CCRCT）和 MEDLINE 数据库中的相关文献，截至 2022 年 2 月 21 日，进行荟萃分析以研究柠檬酸铁治疗 CKD 合并高磷血症和贫血患者的疗效、安全性和经济效益。两名审查员使用 RevMan 软件（版本 5.3）独立进行荟萃分析。
本研究共纳入 16 项随机临床试验（RCT），涉及 1754 名参与者。荟萃分析显示，与安慰剂对照组相比，柠檬酸铁可显著降低 CKD 患者的血清磷（MD-1.76mg/dL，95%CI（-2.78，-0.75）； = 0.0007）。相比之下，柠檬酸铁治疗与非铁基磷酸盐结合剂、司维拉姆、碳酸钙、碳酸镧和柠檬酸亚铁等活性对照之间的差异无统计学意义（MD-0.09mg/dL，95%CI（-0.35，0.17）； = 0.51）。然而，与活性药物（MD0.43g/dL，95%CI（0.04，0.82）； = 0.03）和安慰剂组（MD0.39g/dL，95%CI（0.04，0.73）； = 0.03）相比，柠檬酸铁可有效改善血红蛋白水平。根据八项研究，与对照药物相比，柠檬酸铁被认为是一种具有成本效益的治疗方法。柠檬酸铁治疗后大多数不良事件（AE）均为轻度。
综上所述，我们的综述表明，铁基磷酸盐结合剂柠檬酸铁是治疗 CKD 合并高磷血症和贫血患者的有效且安全的治疗选择。更重要的是，这种替代治疗方法可能更便宜。然而，需要更多的科学研究来验证我们的发现。
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