Velphoro: Indication and Use
Velphoro (sucroferric oxyhydroxide) is a phosphate binder indicated for the control of serum phosphorus levels in adults and pediatric patients 9 years of age and older with chronic kidney disease (CKD) on dialysis. 1
Primary Indication
Velphoro functions as an iron-based phosphate binder specifically designed to manage hyperphosphatemia in dialysis-dependent CKD patients. 1 The medication works by binding dietary phosphate in the gastrointestinal tract, thereby reducing phosphorus absorption and lowering serum phosphorus concentrations. 2, 3
Mechanism and Clinical Context
Hyperphosphatemia is a common and serious complication in dialysis patients that requires pharmacologic management when dietary phosphorus restriction alone is insufficient. 4, 5 The condition contributes to CKD-mineral bone disorder, characterized by secondary hyperparathyroidism, altered bone morphology, increased fracture risk, and development of vascular calcifications. 2
Key Advantages Over Other Phosphate Binders
Lower pill burden: Velphoro requires significantly fewer tablets per day (average 3-4 tablets) compared to sevelamer carbonate (average 10 tablets), which improves treatment adherence. 3, 6
Non-calcium based: Unlike calcium-containing phosphate binders, Velphoro does not increase the risk of hypercalcemia or contribute to vascular calcification. 4, 2
Minimal iron absorption: Despite being iron-based, sucroferric oxyhydroxide exhibits minimal systemic iron absorption (<1%), reducing concerns about iron accumulation and toxicity. 7, 5
High phosphate-binding capacity: The medication demonstrates potent phosphate-binding properties across the physiological pH range of the gastrointestinal tract. 7
Important Clinical Note
Velphoro is NOT used as an iron supplement for treating anemia. 4 The guideline explicitly states that "sucroferric oxyhydroxide is not included on this list [of oral iron agents for treating anemia] as it is poorly absorbed." 4 Its sole approved indication is phosphate binding in dialysis patients, not iron repletion.
Dosing Considerations
Adults and pediatric patients ≥12 years: Start with 500 mg three times daily with meals. 1
Pediatric patients 9 to <12 years: Start with 500 mg twice daily with meals. 1
Titration: Adjust dose in 500 mg increments/decrements as needed to achieve target serum phosphorus levels, with monitoring as frequently as weekly. 1
Administration: Tablets must be chewed or crushed, never swallowed whole, and always taken with meals. 1