Expert Perspectives on Hyperphosphatemia Management in CKD: A Focus on Sucroferric Oxyhydroxide and Phosphate Binders

Calcium and phosphorus homeostasis is crucially regulated by interactions between the kidneys, intestines, and bones, with key hormones like vitamin D, parathyroid hormone (PTH), and fibroblast growth factor 23 playing central roles. As chronic kidney disease (CKD) advances, especially to end-stage renal disease (ESRD), this balance is disrupted, leading to hyperphosphatemia, characterized by serum phosphorus levels >4.5 mg/dL. Hyperphosphatemia is a significant risk factor for cardiovascular complications and mortality in CKD patients, with prevalence ranging from 21% to 40% in those on dialysis, varying by region due to dietary patterns and dialysis practices. Effective management includes dietary phosphorus restriction and phosphate binders(PBs). Sucroferric oxyhydroxide (SO), an iron-based PB, has shown promise due to its ability to reduce serum phosphorus with a lower pill burden compared to alternatives like sevelamer. This expert opinion aimed to guide SO use in CKD patients with hyperphosphatemia. The experts from various regions of India convened for a structured discussion moderated through live polling. Key insights emphasized that SO is effective, well-tolerated, and cost-effective, offering improved patient adherence due to reduced pill burden. This guidance is intended to enhance treatment strategies, optimize patient outcomes, and address gaps in current clinical practice for managing hyperphosphatemia in CKD.