Role of Ferric Citrate in Correcting Anemia Among Chronic Kidney Disease Patients on Maintenance Hemodialysis

Author(s): Rafi SMR, Ahmed AHH, Rahman AKMS, Jahan N, Uddin MB, Raju MC, Shamsuzzaman SM, Sarker MSA, Arnob AS, Gashiyah T.

Background: In chronic kidney disease (CKD), anemia and hyperphosphatemia are significant complications. Anemia due to erythropoietin and iron deficiencies, often requires supplementation. Phosphate binders including ferric citrate, sevelamer carbonate, and calcium acetate are crucial for managing hyperphosphatemia, as they prevent the absorption of dietary phosphate. Objective: Present study was aimed to assess the role of ferric citrate in correcting anemia among CKD patients on maintenance hemodialysis (MHD). Methods: This randomized control trial was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, that enrolled 45 adult CKD patients on hemodialysis. Study population were divided into equal three groups to compare the effects of ferric citrate, sevelamer carbonate, and calcium acetate. Of these groups, ferric citrate was the intervention group, whereas sevelamer carbonate and calcium acetate were the active control group. Data were collected through interviews and medical evaluations, including serum hemoglobin level and iron status. The focus was on the role of ferric citrate in correcting anemia and iron status among maintenance hemodialysis (MHD) patients. Results: In this study with CKD patients undergoing hemodialysis, the majority of participants were male across all groups. Initially, no significant differences were observed in serum hemoglobin, iron, and transferrin saturation (TSAT) level among the groups. However, after three months of treatment, significant (p<0.05) improvements were noted in the intervention group, with increases in hemoglobin level from 9.39 ± 1.08 g/dl to 10.6 ± 0.89 g/dl and in serum iron level from 50.8 ± 17.0 μg/dl to 118.2 ± 35.5 μg/dl. Transferrin saturation was also raised significantly from 23.5% to 45%. In contrast, the control groups did not show significant changes in these parameters. Ferric citrate significantly (p<0.05) increases serum ferritin level from 344 ng/ml to 568 ng/ml. No significant changes were noted in total iron binding capacity (TIBC) level across all phosphate binders. Conclusion: The study indicates that ferric citrate is better at correcting hemoglobin level and iron status in CKD patients on MHD than sevelamer carbonate and calcium acetate. Therefore, ferric citrate can be used as a primary treatment for the correction of anemia in MHD patients