Long-Term Effect of Ferric Citrate Hydrate on Mineral Metabolism and Anemia in Maintenance Hemodialysis Patients

Background: Ferric citrate hydrate is a phosphate (P)-binder drug that is indicated for patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis (MHD). Objectives: The objectives of this study were to evaluate the changes in the serum mineral metabolism biomarker levels and treatment status of anemia in MHD patients receiving ferric citrate hydrate. Methods: A total of 132 adult dialysis patients were enrolled in this study. Bone turnover marker levels, anemia status and iron biomarker levels over a period of 18 months after the start of the ferric citrate hydrate treatment were extracted from the medical records of the patients. Results: At enrollment, 14 (10.6%) patients were P-binder-naïve, and 118 (89.4%) patients were receiving other P-binders. The serum P level before the start of ferric citrate hydrate treatment was ≤5.5 mg/dL in 18.8% of the patients. After 18 months of ferric citrate hydrate treatment, the proportion of patients with serum P levels ≤ 5.5 mg/dL increased to 47.7%. The mean ± standard error of the mean (SEM) of the serum P level was 7.05 ± 0.14 mg/dL at the baseline, and decreased to 5.83 ± 0.17 mg/dL after 18 months of treatment with ferric citrate hydrate. The mean ± SEM of the serum hemoglobin (Hb), ferritin, and transferrin saturation (TSAT) levels were 11.96 ± 0.76 g/dL, 71.13 ± 6.09 ng/mL, and 25.19% ± 1.21%, respectively, at the baseline, and 11.45 ± 0.13 g/dL, 124.94 ± 8.62 ng/mL, and 26.18% ± 0.99%, respectively, after 18 months of ferric citrate hydrate treatment. Conclusions: These results suggest that the serum P and anemia biomarker levels observed in this study were similar to those reported in clinical trials.

A Low Serum Albumin Level Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Background: Cardiovascular (CV) diseases are the most frequent cause of death in hemodialysis (HD) patients. The aim of this study was to identify risk factors for CV events in HD patients with preserved left ventricular ejection fraction (PEF). Objectives: A total of 213 HD patients (69 years, 64.1% males) were enrolled. Demographic, laboratory test, and echocardiographic data were recorded, and CV events during the 32-month follow-up period were documented. Results: During the follow-up period, 31 patients (14.6%) died and 50 patients (23.5%) suffered a fatal or nonfatal CV event. Age and serum albumin, C-reactive protein, total cholesterol, non-HDL cholesterol, and NT-proBNP levels were associated with CV events according to a univariate analyses. A multivariate analysis identified a low serum albumin value

An Invitation of the Combination of the Geriatric Nutritional Risk Index and the Triglyceride to High-Density Lipoprotein Cholesterol Ratio as a Mortality Predictor in Maintenance Hemodialysis Patients

Background: The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been shown to be a predictor of cardiovascular (CV) outcomes in the general population. Objectives: The aim of this study was to determine whether the combination of GNRI and TG/HDL-C ratio is a predictor of all-cause mortality and CV deaths in maintenance hemodialysis (MHD) patients. Methods: We performed a retrospective, observational cohort study in which we enrolled 341 MHD patients from a single center in Japan who had been followed up for a mean of 48.0 ± 12.7 months. The outcomes were defined as the occurrence of all-cause mortality and CV deaths during the follow-up period. Baseline GNRI and TG/HDL-C ratios were investigated for associations with outcomes by using Cox proportion hazards models adjusted for demographic parameters. Results: Overall, 101 of the subjects had died, of whom 52 died due to CV events during the mean follow-up period of 48.0 ± 12.7 months. The patients were grouped into four categories according to a median GNRI Conclusion: The combination of GNRI and TG/HDL-C ratio is an easily accessible marker for predicting all-cause mortality and CV deaths in MHD patients.