Ferric citrate in end-stage kidney disease as a phosphate binder and source of iron: a review of clinical trials

Author(s): Diana I Jalal, Mohammed Sika, Jamie P Dwyer, Ingrid J Chang, Barbara A Greco, Marvin Sinsakul, Simin Goral & Kausik Umanath

Hyperphosphatemia is highly prevalent among patients with end-stage kidney disease and is a major risk factor for cardiovascular disease and mortality. The contemporary management of hyperphosphatemia consists of oral phosphate binders for maintenance of normal serum phosphorus levels. Although several phosphate binders are currently available, limitations related to tolerability, safety, effectiveness, cost and pill burden have prompted the development of newer agents. Ferric-based compounds have been recognized to reduce phosphate absorption since the 1930s. In this manuscript, we review the recently available data on the use of ferric citrate with a focus on human studies that have led to its approval as a phosphate binder by the US FDA.