Supplementary Material for: Serum phosphorus management with sucroferric oxyhydroxide as a first-line phosphate binder within the first year of hemodialysis

Introduction: Sucroferric oxyhydroxide (SO), a non-calcium, chewable, iron-based phosphate binder (PB), effectively lowers serum phosphorus (sP) concentrations while reducing pill burden relative to other PBs. To date, SO studies have largely examined treatment-experienced, prevalent hemodialysis populations. We aimed to explore the role of first-line SO initiated during the first year of dialysis.
Methods: We retrospectively analyzed de-identified data from adults receiving in-center hemodialysis who were prescribed SO monotherapy within the first year of hemodialysis as part of routine clinical care. All patients continuing SO monotherapy for 12 months were included. Changes from baseline in sP, achievement of sP ≤5.5 and ≤4.5 mg/dL, and other laboratory parameters were analyzed quarterly for one year.
Results: The overall cohort included 596 patients, 286 of whom had a dialysis vintage ≤3 months. In the 3 months preceding SO initiation, sP rapidly increased (mean increases of 1.02 mg/dL and 1.65 mg/dL, in the overall cohort and incident cohort, respectively). SO treatment was associated with significant decreases in quarterly sP (mean decreases of 0.26-0.36; p<0.0001 for each quarter and overall). While receiving SO, 55%-60% of patients achieved sP ≤5.5 mg/dL and 21%-24% achieved sP ≤4.5 mg/dL (p<0.0001 for each quarter and overall vs baseline). Daily PB pill burden was approximately 4 pills. Serum calcium concentrations increased and intact parathyroid hormone concentrations decreased during SO treatment (p<0.0001 vs baseline).
Conclusions: Among patients on hemodialysis, initiating SO as a first-line PB resulted in significant reductions in sP while maintaining a relatively low PB pill burden.

引言：蔗糖氢氧化铁（Sucroferric oxyhydroxide，SO）是一种非含钙、可咀嚼的铁基磷酸盐结合剂（phosphate binder，PB），可有效降低血清磷（serum phosphorus，sP）水平，且相较于其他磷酸盐结合剂，其服药负担更低。截至目前，相关蔗糖氢氧化铁研究大多针对经治的维持性血液透析人群展开。本研究旨在探究透析初始1年内启用一线蔗糖氢氧化铁治疗的临床价值。
方法：本研究回顾性分析了常规临床诊疗中，于血液透析初始1年内接受蔗糖氢氧化铁单药治疗的成人中心血液透析患者的去标识化数据。纳入持续接受12个月蔗糖氢氧化铁单药治疗的所有患者。连续12个季度分析患者血清磷水平较基线的变化、血清磷≤5.5mg/dL及≤4.5mg/dL的达标率，以及其他实验室指标的变化情况。
结果：总队列共纳入596例患者，其中286例患者透析龄≤3个月。在启用蔗糖氢氧化铁治疗前的3个月内，总队列及新发透析队列患者的血清磷水平均快速升高，平均增幅分别为1.02mg/dL与1.65mg/dL。蔗糖氢氧化铁治疗与各季度血清磷水平的显著降低相关，平均降幅为0.26~0.36mg/dL；各季度及总体比较均p<0.0001。接受蔗糖氢氧化铁治疗期间，55%~60%的患者血清磷达到≤5.5mg/dL的标准，21%~24%的患者达到≤4.5mg/dL的标准；与基线相比，各季度及总体比较均p<0.0001。每日磷酸盐结合剂服药负担约为4片。蔗糖氢氧化铁治疗期间，患者血清钙水平升高，全段甲状旁腺激素（intact parathyroid hormone，iPTH）水平降低，与基线相比差异均有统计学意义（p<0.0001）。
结论：在血液透析患者中，以蔗糖氢氧化铁作为一线磷酸盐结合剂启动治疗，可在显著降低血清磷水平的同时，维持较低的磷酸盐结合剂服药负担。