Efficacy of Ferric Citrate as Phosphate Binder Among End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Randomized Controlled Trial

Background: End-stage renal disease (ESRD) patients primarily use phosphate binders to manage hyperphosphatemia. Recently, ferric citrate has shown promise as a safer and more acceptable alternative. Objective: The study aimed to evaluate the efficacy of ferric citrate in patients with ESRD undergoing maintenance hemodialysis in Bangladesh. Methods: This open-label randomized controlled trial (RCT) was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from August 2022 to March 2023. A total of 45 patients on maintenance hemodialysis with CKD stage 5D were randomized into three groups: Group A (ferric citrate), Group B (sevelamer carbonate), and Group C (calcium acetate) and were treated for three months. Intact parathyroid hormone (iPTH), inorganic phosphate, and corrected calcium levels were measured at baseline and after three months. Results: Baseline demographics and comorbidities were similar across groups. After three months, all groups showed significant reductions in serum phosphate: Group A (ferric citrate) [median (range): 4.5 (4.0-7.0) to 4.2 (3.2-6.9) (mg/dl)], Group B (sevelamer carbonate) [median (range): 5.9 (4.37-7.80) to 5.4 (3.2-7.00) (mg/dl)], and Group C (calcium acetate) [median (range): 5.6 (4.2-7.0) to 5.0 (3.8-6.8) (mg/dl)]. iPTH levels also decreased significantly in all groups. Corrected calcium increased significantly only in Group C [median (range): 8.8 (8.2-9.9) to 10.0 (9.4-10.9) (mg/dl)], with no significant changes in Groups A and B. Conclusion: Ferric citrate is an effective and safe option to use as a first-line treatment for hyperphosphatemia in ESRD patients undergoing maintenance dialysis.