Ferric citrate shows benefits over ferrous sulfate for treating iron deficiency in CKD
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Ferric citrate may be more effective than ferrous sulfate for treating iron deficiency in patients with chronic kidney disease, according to this study.
“It is unknown whether the effects of ferric citrate on serum iron parameters substantively differ from ferrous sulfate, the most frequently used oral iron supplement,” Rebecca Womack, of the University of Alabama at Birmingham, and colleagues wrote. “This is important in that ferrous sulfate has been shown to be relatively efficacious in increasing iron concentrations and hemoglobin in individuals with CKD not requiring dialysis and is available over the counter.”
Adding that it is also unclear whether ferric citrate may be more effective than ferrous sulfate in reducing FGF23 “by both increasing circulating iron and restricting phosphate absorption,” the researchers randomized 60 adults to either medication for 12 weeks. Both medications were taken three times a day, with ferric citrate prescribed as 2 grams per dose and ferrous sulfate as 325 mg per dose.
Though the primary outcomes of the study were the changes in transferrin saturation [TSAT] and ferritin from baseline, the researchers also considered changes in hemoglobin, fibroblast growth factor 23 (FGF23), and hepcidin.
At 12 weeks, greater increases in both TSAT and ferritin were observed in patients taking ferric citrate vs. ferrous sulfate (between-group difference in mean change, 8% and 37 ng/mL, respectively). Treatment with ferric citrate also led to a greater increase in hepcidin (between-group difference, 69 pg/mL), though there were no between-group differences for the other measures.
Regarding safety profiles, researchers found no differences in adverse events between groups, with gastrointestinal complications being the most commonly reported.
Womack and colleagues addressed this finding, noting patients with CKD have high circulating concentrations of hepcidin, which results in reduced iron absorption in the gut. “Using oral iron supplementation at high doses to overcome this block often causes gastrointestinal side effects, limiting the total quantity of elemental iron that can be delivered via the gastrointestinal tract with standard formulations,” they wrote.
Still, both drugs were generally well tolerated, according to the researchers, with no serious adverse events or deaths occurring during the study period.
“These findings add to the current literature by showing that oral ferric citrate not only increases circulating TSAT and ferritin in patients with CKD, but it appears to do so more effectively than ferrous sulfate,” they concluded.
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