Efficacy And Safety Of Ferric Citrate In Treatment Of Hyperphosphatemia In Patients With Chronic Kidney Disease: A Meta-analysis

Objective:To evaluate the efficacy and safety of ferric citrate in treatment of hyperphosphatemia in patients with chronic kidney disease（CKD）,and provide evidence-based evidence for clinical medication.Methods:The randomized controlled trials（RCTs）relating to treatment of hyperphosphatemia in patients with CKD were searched from the databases of Cochrane Library,Pub Med,EMBase,and Web of Science.We used software Rev Man5.3 to perform the Meta-analysis of the included RCTs to distinguish the efficacy and safety of ferric citrate versus placebo or other phosphorus binding agents in treatment of hyperphosphatemia in patients with CKD.Results:A total of 1906 cases in 11 RCTs was included.Our research showed that ferric citrate did better in alleviating hyperphosphatemia than the control group [MD=-0.68,95%CI（-1.24,-0.12）,P=0.02],where it reduced serum phosphorus compared with placebo [MD=-1.43,95%CI（-2.20,-0.66）,P<0.01] and was not inferior to other phosphorus binders [MD=0.18,95%CI（-0.14,0.50）,P=0.28].Furthermore,ferric citrate significantly improved hemoglobin [MD=0.60,95%CI（0.37,0.82）,P<0.01],ferritin [MD=88.24,95%CI（53.80,122.67）,P<0.01],transferrin saturation [MD=10.65,95%CI（7.21,14.09）,P<0.01] and hematocrit [MD=1.67,95%CI（0.45,2.89）,P=0.008].In terms of adverse events,the incidence of diarrhea was higher in ferric citrate then both the placebo and the active treatment [OR=2.68,95%CI（1.76,4.08）,P<0.01],and the incidence of constipation [OR=1.62,95%CI（0.52,5.01）,P=0.40] and bloating [OR=1.89,95%CI（0.72,4.96）,P=0.20] did not differ significantly between ferric citrate and placebo group or active treatment.Conclusion:Compared with the controlled group,ferric citrate can effectively reduce serum phosphorus in patients with CKD and hyperphosphatemia,and also improve renal anemia.But it has a high incidence of diarrheal in adverse events.