Effects of Iron-Containing Phosphate Binders on Renal Function in Patients with End-Stage Renal Disease

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https://storage.unitedwebnetwork.com/files/1099/976f9e772b19437b08deb511a90a8de1.pdf

Abstract Title *

Effects of Iron-Containing Phosphate Binders on Renal Function in Patients with End-Stage Renal Disease

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Co-author 1

Toshiki Kano tkano@juntendo.ac.jp Juntendo University Nerima Hospital Department of Nephrology Tokyo Japan * Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan

Co-author 2

Hiroaki Io hiroaki@juntendo.ac.jp Juntendo University Nerima Hospital Department of Nephrology Tokyo Japan -

Co-author 3

Koji Sato k.sato.us@juntendo.ac.jp Juntendo University Nerima Hospital Department of Nephrology Tokyo Japan -

Co-author 4

Haruna Ishii h-fukuzaki@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 5

Takuya Maeda ta-maeda@juntendo.ac.jp Juntendo University Nerima Hospital Department of Nephrology Tokyo Japan -

Co-author 6

Junichiro Nakata jnakata@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 7

Yusuke Suzuki yusuke@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

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Co-author 15

Introduction

The fibroblast growth factor-23 (FGF23)- alpha Klotho (αKlotho) system plays a crucial role in maintaining phosphorus homeostasis. On the other hand, the renal protective effects of iron in patients with end-stage renal disease (ESRD) have been recently reported. This study investigated the renal protective effect of iron-containing phosphate binders and its association with the FGF23-αKlotho system in ESRD patients.

Methods

Sixty-five patients with ESRD and hyperphosphatemia who met the eligibility criteria for the clinical study (UMIN000019385) were enrolled. These patients were randomly assigned to either the iron-containing phosphate binder group or the non-iron phosphate binder group, and a prospective randomized parallel-group comparative trial was conducted. The changes in various parameters, including estimated glomerular filtration rate (eGFR), serum FGF23, soluble αKlotho, serum phosphorus, and serum iron levels such as ferritin and Transferrin saturation (TSAT) were observed over 2 years.

Results

Ferritin and TSAT levels increased significantly in the iron-containing phosphate binder group. Both groups showed a decline in eGFR over time, however the eGFR decline was significantly greater in the non-iron-containing group compared to the iron-containing group. Although serum FGF23 level increased in both groups, the level tended to be lower in the iron-containing group. αKlotho level increased in the iron-containing group, however decreased in the non-iron-containing group. Furthermore, the change in αKlotho level over one year correlated with the degree of eGFR decline.

Conclusion

αKlotho decreases during the progression of renal failure. However, administration of iron-containing phosphate binders increased αKlotho, suggesting a potential role in suppressing renal function decline. This study indicates a possible renal protective effect of iron-containing phosphate binders mediated by the FGF23-αKlotho system.

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