Changes in Serum Phosphorus Among In-Center Hemodialysis (HD) Patients Initiating Sucroferric Oxyhydroxide (SO) as Part of Routine Care After Kidney Transplant Failure: A 6-Month Follow-Up Study

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Background: Information on serum phosphorus (sP) management in patients who experience kidney transplant failure (KTF) and initiate dialysis is scarce. This retrospective database analysis aims to assess sP management with sucroferric oxyhydroxide (SO), an iron-based phosphate binder (PB), in post-KTF HD patients (pts) over a 6-month period. Methods: Eligible pts were adult post-KTF HD pts from Fresenius Kidney Care first prescribed SO monotherapy during 5/2018- 12/2019 who had sP measured in the month before SO start (baseline; BL). Included in the analysis were pts who initiated SO within 12 months from start of post-KTF HD. Comparisons were made between BL and the monthly follow up (FU; M1 through M6). Monthly or quarterly means were calculated using mixed effects linear regression for PB pill burden and lab measurements. A subgroup analysis was performed in pts with post-KTF HD< 3 months. Results: At BL, pts (n=100) had mean age of 49 years and were on HD for an average of 5 months post-KTF. No PB prescriptions were recorded for 35% overall and 30% for pts with HD <3 months post-transplant. For the overall pts prescribed PB, most were prescribed sevelamer (45%) or calcium acetate (31%). Among pts with HD <3 months post-KTF, fewer patients were on calcium acetate (15%) and more on ferric citrate (19%, compared to 8% overall). After switching to SO, % of pts with sP≤ 5.5 mg/dL increased from 20% to 26%- 35% during SO FU, with fewer PB pills per day in all pts; the trends were similar in pts with post-KTF HD < 3 months (Table). Significant decreases of serum calcium (sCa) and iPTH were also observed. Conclusions: During a 6-month follow-up, significant reductions in sP, PB pills/day, serum calcium and iPTH were observed after pts switched to sucroferric oxyhydroxide within 1 year of returning to HD after kidney transplant failure. Funding: Commercial Support - Fresenius Medical Care

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