Chronic kidney disease associated
mineral and bone disorders arise as a result of aberrant bone
mineral metabolism in patients with advancing levels of renal dysfunction and
end-stage renal disease. One of the cornerstones of treatment is the use of
phosphate-binding agents. We describe the rationale and study design for a clinical trial to assess the safety and efficacy of
ferric citrate as a
phosphate binder. This trial is a three-period, international, multicenter, randomized, controlled clinical trial to assess the safety and efficacy of
ferric citrate as a
phosphate binder, consisting of a 2-week washout period, a 52-week safety assessment period in which subjects are randomized to
ferric citrate or active control, and a 4-week efficacy assessment period in which subjects randomized to
ferric citrate in the safety assessment period are randomized to
ferric citrate or placebo. Eligible subjects include
end-stage renal disease patients who have been treated with thrice-weekly
hemodialysis or
peritoneal dialysis for at least 3 months in dialysis clinics in the United States and Israel. Primary outcome measure will be the effect of
ferric citrate vs. placebo on the change in serum
phosphorus. Safety assessments will be performed by monitoring adverse events, concomitant medication use, and sequential blood chemistries (including
iron parameters,
phosphorus, and
calcium). This three-period trial will assess the efficacy of
ferric citrate as a
phosphate binder. If proven safe and efficacious,
ferric citrate will likely provide an additional
phosphate binder to treat
chronic kidney disease associated
mineral and bone disorders.