Research and Development, Akebia Therapeutics Inc., Cambridge, Massachusetts, USA.
New York Practice, Milliman, Inc., New York, New York, USA.
Nephron. 2023;147(10):583-590. doi: 10.1159/000530230. Epub 2023 Mar 30.
For patients with chronic kidney disease (CKD), the need for phosphate binder (PB) treatment peaks at onset of dialysis. This real-world study assessed rates of PB utilization and switching in patients with dialysis-dependent CKD (DD-CKD).
We identified patients with PB utilization among those with prevalent DD-CKD using 2018-2019 Medicare Parts A/B/D data. Patients were assigned to cohorts based on primary (most frequently used) PB among calcium acetate, ferric citrate, lanthanum carbonate, sevelamer (hydrochloride and carbonate), sucroferric oxyhydroxide. We measured proportion of patients who were adherent (proportion of days covered >80%) and persistent (patients whose last 90 days of outpatient dialysis reported PB use). Net switching rates were calculated as the difference between switches to and from the primary agent.
We identified 136,912 patients with PB use. Proportion of patients adherent ranged from 63.8% (lanthanum carbonate) to 67.7% (sevelamer) and persistent from 85.1% (calcium acetate) to 89.5% (ferric citrate). Most patients (73%) used the same PB throughout the study. Overall, 20.5% of patients experienced one switch and 2.3% two or more. Positive net switching rates were observed for ferric citrate, sucroferric oxyhydroxide, and lanthanum carbonate (2-10%) but negative for sevelamer and calcium acetate (-2% to -7%).
Adherence and persistence rates were low with slight variation across PBs. Net positive switching occurred for ferric citrate, sucroferric oxyhydroxide, and lanthanum carbonate. Further studies are needed to determine the reasons for these findings and could identify opportunities for better control of phosphate levels among patients with CKD.
对于患有慢性肾脏病（CKD）的患者，在开始透析时，对磷酸盐结合剂（PB）的治疗需求达到峰值。这项真实世界的研究评估了透析依赖型 CKD（DD-CKD）患者中 PB 的使用率和转换率。
我们使用 2018-2019 年 Medicare 部分 A/B/D 数据，在有 PB 应用的患者中确定了有 DD-CKD 患者。患者根据醋酸钙、柠檬酸铁、碳酸镧、盐酸和碳酸盐形式的司维拉姆、蔗糖铁氧羟化物等主要（最常使用）PB 分组。我们测量了符合条件的患者的比例（覆盖率 >80%的天数）和持续性（最后 90 天门诊透析报告 PB 使用的患者）。净转换率的计算方法是从主要药物转换而来的差异。
我们确定了 136912 名有 PB 应用的患者。符合条件的患者中，有 63.8%（碳酸镧）至 67.7%（司维拉姆）的患者具有较高的依从性，85.1%（醋酸钙）至 89.5%（柠檬酸铁）的患者具有较高的持续性。大多数患者（73%）在整个研究期间使用相同的 PB。总体而言，20.5%的患者经历了一次转换，2.3%的患者经历了两次或更多次转换。柠檬酸铁、蔗糖铁氧羟化物和碳酸镧的正净转换率为 2-10%，而司维拉姆和醋酸钙为-2%至-7%。
不同 PB 之间的使用率和持续性率略有变化，且转换率为正。柠檬酸铁、蔗糖铁氧羟化物和碳酸镧发生了正净转换。需要进一步研究以确定这些发现的原因，并确定改善 CKD 患者磷酸盐水平控制的机会。
