From the Guidelines
Auryxia (ferric citrate) is recommended as a first-line treatment for hyperphosphatemia in patients with chronic kidney disease on dialysis and iron deficiency anemia in patients with chronic kidney disease not on dialysis, due to its ability to bind dietary phosphate and provide a source of iron. The typical starting dose for hyperphosphatemia is 2 tablets (210 mg ferric iron per tablet) three times daily with meals, which can be adjusted by 1-2 tablets per day every 2-4 weeks based on phosphorus levels, with a maximum of 12 tablets daily 1. For iron deficiency anemia, the usual dose is 1 tablet three times daily with meals. Auryxia works by binding dietary phosphate in the gastrointestinal tract to reduce absorption for hyperphosphatemia management, while also providing a source of iron that can be absorbed to treat anemia.
Key Benefits and Considerations
- Auryxia has been shown to increase TSAT, ferritin, and Hb, together with lowering serum phosphate, FGF23 levels, i.v. iron needs, and ESA needs in patients with chronic kidney disease 1.
- Common side effects include discolored (dark) stools, diarrhea, constipation, and nausea.
- Patients should be aware that Auryxia may reduce the absorption of certain medications, so they should take other oral medications at least 1 hour before or 2 hours after taking Auryxia.
- Regular monitoring of phosphorus, iron parameters, and kidney function is necessary while taking this medication.
Comparison to Other Treatments
- Oral iron preparations, such as ferrous sulfate, ferrous fumarate, and ferrous gluconate, may be less effective than Auryxia in treating iron deficiency anemia in patients with chronic kidney disease 1.
- Intravenous iron formulations, such as iron sucrose and ferric carboxymaltose, may be associated with a higher risk of adverse reactions and are typically reserved for patients who are intolerant or unresponsive to oral iron therapy 1.
From the Research
Auryxia Overview
- Auryxia, also known as ferric citrate, is a medication used to treat iron deficiency anemia in patients with chronic kidney disease (CKD) [(2,3,4,5,6)].
- It is also used as a phosphate binder to control serum phosphate levels in adult CKD patients treated with dialysis 3.
Mechanism of Action and Clinical Attributes
- Auryxia has a unique mechanism of action that allows it to be effective in treating both iron deficiency anemia and hyperphosphatemia in CKD patients 3.
- It has been shown to decrease serum phosphate levels and improve iron parameters in patients with CKD [(3,6)].
- Auryxia also has a positive effect on fibroblast growth factor 23 (FGF23) levels, which are often elevated in CKD patients 3.
Efficacy and Safety
- Studies have demonstrated the efficacy and safety of Auryxia in treating iron deficiency anemia and hyperphosphatemia in CKD patients [(2,4,5,6)].
- Auryxia has been shown to increase hemoglobin levels and decrease serum phosphate concentrations in CKD patients [(2,5,6)].
- Common adverse events associated with Auryxia include gastrointestinal symptoms such as diarrhea, abdominal pain, and discolored feces [(5,6)].
Use in Specific Patient Populations
- Auryxia has been studied in patients with CKD and heart failure, and has been shown to be effective in treating iron deficiency anemia in this population 4.
- It has also been studied in patients with nondialysis-dependent CKD, and has been shown to be safe and effective in this population [(2,5)].