Effects of Ferric Citrate Hydrate on Calciprotein Particle Levels and Aortic Arch Calcification Progression in Patients on Maintenance Hemodialysis: A Comparison with Calcium Carbonate

Background: Arterial calcification is a predictive marker in patient on hemodialysis (HD), but the relationship between arterial calcification and calciprotein particles (CPPs) is unclear. Methods: We examined the effects of ferric citrate hydrate (JTT-751) on CPP level and evaluated changes in aortic arch calcification (AoAC) grade in patients on maintenance HD (MHD). In total, 70 MHD patients were enrolled in the study and followed for 24 months. We measured serum CPP levels and fibroblast growth factor 23 (FGF 23) among propensity score-matched MHD patients. One group (n = 35) was treated with CaCO3 and the other (n = 35) was treated with ferric citrate hydrate (JTT-751). AoAC was assessed on chest-X rays. Eligible patients continued the same treatment. Results: All 70 patients completed the study. Serum CPP levels reduced in the JTT-751 group, but were not significantly different in the CaCO3 group. Among patients whose baseline AoAC score (AoACS) was ≤ 4 (median), median AoACS increased from 0 (0 - 3) to 3 (2 - 4) (p < 0.05) and Δ% AoACS was 2 (0% - 4%) in the JTT-751 group. In the CaCO3 group, median AoACS increased from 2 (0 - 2) to 3 (0 - 4) (p < 0.05) and Δ% AoACS was 1 (0% - 3%). Conclusion: These results indicate that the administration of JTT-751 decreased serum CPP levels but did not inhibit AoAC progression in patients on MHD.