Efficacy and safety of ferric citrate for patients with chronic kidney disease:a Meta-analysis

Objective To evaluate the efficacy and safety of ferric citrate for chronic kidney disease(CKD) patients with iron deficiency anemia and hyperphosphatemia. Methods Randomized controlled trials on the treatment of CKD with ferric citrate were retrieved from the databases of PubMed,Embase,MedLine,Cochrane Library,Ovid,CNKI,CBM,WanFang and Weipu from the inceptions until March 2020. According to the risk bias assessments of Cochrane Collaboration,the quality of included literature was evaluated and RevMan 5.3 software utilized for a Meta-analysis of efficacy and adverse reactions. Results A total of 13 articles involving 2,146 patients were included. According to whether or not receiving dialysis,they were divided into two groups of dialysis-dependent CKD(DD-CKD) and non-dialysis-dependent CKD(NDD-CKD). Both groups were compared with control group(placebo or active treatment). The hemoglobin level of patients in test group was higher than that of control group DD-CKD:(MD=0.52,95%CI:0.18~0.87,P=0.003),NDD-CKD:(MD=0.73,95%CI:0.53~0.93,P<0.001). It could effectively reduce serum phosphorus level in NDD-CKD patients(MD=-0.65,95%CI:-0.960~-0.33,P<0.001);in DD-CKD patients,there was no significant inter-group difference(MD=-0.64,95%CI:-1.50~0.20,P=0.14). As compared with placebo,ferric citrate could significantly reduce blood phosphorus level(MD=-2.17,95%CI:-2.43~-1.91,P<0.001). In addition,ferric citrate elevated ferritin level and lowered FGF-23 level. Diarrhea was the most common adverse reaction of ferric citrate. However,the difference was not statistically significant as compared with control group(P>0.05). Conclusion Ferric citrate can effectively treat iron deficiency anemia and hyperphosphatemia in CKD patients. There are no obvious serious short-term adverse reactions. However,its long-term complications and side effects should be further verified by more clinical trials.