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Treatment of elevated serum phosphorus in hemodialysis patients remains challenging due in part to the lack of a well-tolerated, safe, and effective phosphate binder. Here we report the results of a single-center, open-label, phase I clinical trial of 44 hemodialysis patients to show the safety and efficacy of a novel iron-based phosphate binder, SBR759. After establishing its safety at an initial dose of 3.75 g/day, SBR759 was given to successive cohorts in several divided doses of up to 22.5 g/day. The defined measure of efficacy was the average change in serum phosphorus in the cohorts receiving 11.25 and 15.0 g/day, in whom the mean reduction was 2.1 mg/dl. A clinically and statistically significant reduction in serum phosphorus was found across the entire dose range. All patients were able to achieve mean phosphorus levels within K/DOQI target ranges at the end of the first week. SBR759 was well tolerated within the anticipated clinical dose range of 3.75–15 g/day. No treatment-related serious adverse events were observed nor were there clinically relevant changes in iron indices. While these preliminary studies highlight the clinical efficiency and safety of SBR759, its promise of improved therapeutic options for hyperphosphatemia in patients with chronic kidney disease requires further study.

Secondary hyperparathyroidism (SHPT) affects a significant number of hemodialysis patients, and metabolic disturbances associated with it may contribute to their high mortality rate. As patients with lower serum calcium, phosphorus, and parathyroid hormone are reported to have improved survival, we tested whether prescription of the calcimimetic cinacalcet to hemodialysis patients with SHPT improved their survival. We prospectively collected data on hemodialysis patients from a large provider beginning in 2004, a time coincident with the commercial availability of cinacalcet hydrochloride. This information was merged with data in the United States Renal Data System to determine all-cause and cardiovascular mortality. Patients included in the study received intravenous (i.v.) vitamin D therapy (a surrogate for the diagnosis of SHPT). Of 19,186 patients, 5976 received cinacalcet and all were followed from November 2004 for up to 26 months. Unadjusted and adjusted time-dependent Cox proportional hazards modeling found that all-cause and cardiovascular mortality rates were significantly lower for those treated with cinacalcet than for those without calcimimetic. Hence, this observational study found a significant survival benefit associated with cinacalcet prescription in patients receiving i.v. vitamin D. Definitive proof, however, of a survival advantage awaits the performance of randomized clinical trials.