Velphoro Dosing in CKD Patients on Dialysis
The recommended starting dose of Velphoro (sucroferric oxyhydroxide) for adults and pediatric patients 12 years and older with CKD on dialysis is 500 mg (one tablet) three times daily with meals, with titration in 500 mg increments as needed to control serum phosphorus levels. 1
Starting Dose by Age Group
- 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
Dose Titration Strategy
- Monitor serum phosphorus levels and titrate in increments or decrements of 500 mg (one tablet) per day as needed until acceptable serum phosphorus is achieved 1
- Titrate as frequently as weekly based on phosphorus response 1
- If the daily dose cannot be divided equally among meals, administer the larger dose with the largest meal of the day 1
Expected Maintenance Dosing
- Average maintenance dose in adults and patients ≥12 years: 1,500-2,000 mg daily (3-4 tablets) to control serum phosphorus 1
- Average maintenance dose in pediatric patients 9 to <12 years: 1,500 mg daily (3 tablets) 1
- Maximum studied dose: Up to 3,000 mg per day in adults and pediatric patients ≥9 years 1
- Real-world data shows mean doses of approximately 1,000-1,200 mg/day are often effective, with higher baseline phosphorus levels requiring greater doses 2, 3
Administration Requirements
- Tablets must be chewed or crushed—do not swallow whole 1
- Must be taken with meals for optimal phosphate binding 1
- If doses are missed, resume with the next food intake 1
Clinical Efficacy Expectations
- Velphoro achieves approximately 30% reduction in serum phosphorus within 3 months of treatment 2, 4
- The medication demonstrates similar efficacy across all CKD populations: advanced CKD not on dialysis, peritoneal dialysis, and hemodialysis patients 2
- Lower pill burden compared to sevelamer carbonate (average 2.3 pills/day vs higher with sevelamer), which may improve adherence 5, 3
Safety Monitoring and Common Pitfalls
- Most common adverse effects: Diarrhea (14.2% of patients) and discolored feces (9.4%), both typically mild and transient 3
- Diarrhea generally occurs early in treatment and resolves without intervention in most cases 2, 3
- Discontinuation rate: Approximately 14% due to gastrointestinal effects, primarily diarrhea 2
- Iron parameters: Small increases in serum ferritin (+12 to +75 µg/L) may occur, but no clinically significant iron accumulation or toxicity has been demonstrated 3, 6
- Minimal systemic iron absorption (<1% in preclinical studies), reducing risk of iron overload 6
Additional Clinical Benefits
- Treatment is associated with 64% reduction in intact FGF-23 over one year, which may confer cardiovascular benefit 4
- Demonstrates favorable effects on bone metabolism markers, with trends toward increased bone formation 4
- No significant changes in calcium, hemoglobin, or transferrin saturation during treatment 2