Ferric Pyrophosphate Citrate for Anemia in HDD-CKD

Patients with hemodialysis-dependent chronic kidney disease (HDD-CKD) commonly develop anemia. Anemia is related to erythropoietin deficiency, inflammation, and iron deficiency. Routine care includes intravenous (IV) administration of high molecular weight iron oxide nanoparticles (IONP) to replace iron losses, treatment that, while effective, carries concerns about possible safety issues.

In a recent issue of Current Medical Research and Opinion, Steven Fishbane, MD, provides an overview of ferric pyrophosphate citrate (FPC, Triferic*1, Triferic AVNU*), a complex iron salt that donates iron directly to plasma transferrin [doi.org/10.1080/03007995.2022.2092373]. FPC is devoid of any carbohydrate moiety and is administered via the dialysate or intravenously during each hemodialysis session to replace iron and maintain hemoglobin.

Results of controlled clinical trials of up to 48 weeks have shown that the regular administration of dialysate FPC is safe and efficacious for maintaining hemoglobin levels and iron balance in patients with HDD-CKD. Further, clinical data suggest that dialysate FPC may be associated with reductions in dose requirements for and use of erythropoiesis-stimulating agents and IONPs in patients with HDD-CKD.

Safety data from clinical studies and post-marketing surveillance indicate that FPC is well tolerated; there are no associations between FPC and increased risk of infection, inflammation, iron overload, or serious hypersensitivity reactions.

In summary, Dr. Fishbane said, “FPC represents a novel physiologic iron replacement product for the long-term management of hemoglobin levels and iron balance in patients with HDD-CKD. The low doses of iron administered at each hemodialysis provide a well-tolerated and effective means to maintain iron balance. Traditional IV iron products may still be needed to replete IV iron stores in patients experiencing excessive blood or tissue  losses leading to iron deficient anemia.”

1. Triferic and Triferic AVNU are the proprietary name for ferric pyrophosphate citrate. Triferic and Triferic AVNU are registered trademarks of Rockwell Medical Inc.