Sucroferric Oxyhydroxide in Maintenance Hemodialysis: A Retrospective, Comparative Cohort Study

Rationale & Objective: High pill burden associates with reduced phosphate-binder adherence among dialysis patients, contributing to elevated serum phosphorus levels. We compared the real-world effectiveness of sucroferric oxyhydroxide (SO) versus other phosphate binders in hemodialysis patients over 2 years. Study Design: Retrospective cohort study. Setting & Participants: Adult in-center hemodialysis patients prescribed 2 years of uninterrupted SO therapy (maintenance SO; n = 222) compared with patients who discontinued SO therapy (discontinued SO; n = 596) within 90 days of first prescription and switched to other phosphate binder(s) for 2 years. Exposures: Phosphate binders. Outcomes: Achievement of serum phosphorus levels <= 5.5 mg/dL, pill burden, and hospitalizations. Analytical Approach: Comparisons were made quarterly (Q1-Q8) between maintenance SO and discontinued SO using Poisson and mixed-effects linear regression. Results: Patients achieving serum phosphorus levels <= 5.5 mg/dL increased from baseline in maintenance SO (46 [20.7%] to a maximum of 104 [46.8%; P< 0.001]) and discontinued SO (96 [16.1%] to a maximum of 201 [33.7%]; P< 0.001). 100 (45%) maintenance SO patients achieved target serum phosphorus levels at Q8 with 3.1 fewer pills per day from baseline (7.5 to 4.4 pills per day; P< 0.001), and 190 (31.9%) discontinued SO patients achieved serum phosphorus levels 5.5 mg/dL at Q8 with pill burden unchanged (9.1 to 9.3 pills per day; P= 0.3). Among all patients during 2 years, mean serum phosphorus levels decreased by 0.66 mg/dL and -0.45 mg/ dL (maintenance SO vs discontinued SO; P = 0.014), and mean pill burden decreased in maintenance SO (8.5 to 5.1 pills per day; P< 0.001), but not in discontinued SO (11.6 to 10.9 pills per day; P= 0.2). The serum phosphorus level decrease with SO was confirmed in a sensitivity analysis including patients with SO therapy for 2 or fewer years. Compared with discontinued SO, maintenance SO patients had 35.6 fewer hospitalizations per 100 patient-years (incidence rate ratio, 0.75 [95% CI, 0.58-0.96]). Limitations: No data for treatment indication, tolerance, or adherence. Conclusions: Patients maintained on SO therapy were more likely to achieve target serum phosphorus levels, use 50% fewer phosphate-binder pills per day, and have fewer hospital admissions than patients switched to treatment with other binders.