Continuous Soluble Ferric Pyrophosphate (SFP) Iron Delivery Via Dialysate in Hemodialysis Patients
Condition: End Stage Renal Disease
MeSH terms: Kidney Diseases; Kidney Failure, Chronic
Intervention: Soluble Ferric Pyrophosphate in liquid bicarbonate; Placebo: Conventional liquid bicarbonate; Erythrocyte Stimulating Agent (ESA); Intravenous (IV) Iron
Intervention description: Subjects will receive hemodialysis containing SFP at 2 µM (11 µg iron/dL of dialysate) at every dialysis session, for a total duration of 36 weeks.; Subjects will receive hemodialysis containing conventional liquid bicarbonate lacking SFP at every dialysis session, for a total duration of 36 weeks.; ESA was administered according to the recommendation of a blinded central anemia management center (CAMC) based on the weekly hemoglobin value and its rate of change.; Approved IV iron preparations were administered per a protocol driven algorithm when patients serum ferritin value decreased below 200 ug/L.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 108.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: End Stage Renal Disease, Hemodialysis, SFP

Summary:

      The purpose of this study is to compare the clinical safety and efficacy of SFP in sparing
      the need for erythropoiesis stimulating agents (ESAs) required to maintain hemoglobin (hgb)
      levels in chronic hemodialysis subjects who receive SFP via the dialysate versus subjects who
      receive conventional dialysate without iron.
    

Eligibility criteria:

        Main Inclusion Criteria:

          1. Male and female subjects ≥ 18 years of age.

          2. End-stage renal disease undergoing maintenance hemodialysis 3 to 4 times a week for at
             least 4 months and expected to remain on this schedule and be able to complete the
             study. Subjects on a cadaveric transplant list need not be excluded for this reason
             unless there is an identified donor.

          3. Mean Hgb in the range of ≥ 9.5 to ≤ 12.0 g/dL during screening.

          4. The difference between the maximum and minimum Hgb values during screening does not
             exceed 1.0 g/dL.

          5. Mean ferritin ≥ 200 to ≤ 1000 µg/L during screening.

          6. Mean TSAT ≥ 15% to ≤ 40% during screening.

          7. Any and all serum albumin measured during the 2 months preceding randomization must be
             ≥ 3.0 g/dL.

          8. Prescribed ESA dosing remaining in the range of ≥ 4,000 to ≤ 45,000 U/week epoetin or
             ≥ 12.5 to ≤ 200 µg/week darbepoetin during the 6 weeks preceding randomization.

          9. Required IV iron at any time in the 6 months preceding randomization.

        Main Exclusion Criteria:

          1. Vascular access for dialysis is a catheter.

          2. During the 6 months prior to randomization, infection of the vascular access to be
             used at the time of randomization.

          3. Received a total of > 600 mg IV iron during the 6 weeks prior to randomization.

          4. Received any amount of IV or oral iron during the 2 weeks prior to randomization.

          5. Change in prescribed ESA dose:

               1. Any change in prescribed ESA dose within 4 weeks prior to randomization.

               2. The prescribed ESA dose at the time of randomization is > 25% higher or lower
                  than the prescribed dose at 6 weeks prior to randomization.

               3. Change in prescribed type of ESA (e.g., epoetin vs. darbepoetin) or route of
                  administration within 6 weeks prior to randomization.

          6. Actual ESA dosing missed or withheld for a cumulative total of ≥ 1 week for any reason
             during the 6 weeks prior to randomization.

          7. Known cause of anemia other than anemia attributable to renal disease (e.g., sickle
             cell disease, thalassemia, pure red cell aplasia, hemolytic anemia, myelodysplastic
             syndrome, etc.)

          8. Scheduled kidney transplant or a donor has been identified but the transplant has not
             been scheduled.

          9. Known ongoing inflammatory disorder (other than Chronic Kidney Disease), such as
             systemic lupus erythematosus, rheumatoid arthritis, other collagen-vascular diseases,
             etc.

        11. Known active tuberculosis, fungal, viral, or parasitic infection requiring
        anti-microbial therapy or anticipated to require anti-microbial therapy during the
        patient's participation in this study. Subjects with hepatitis C, in the absence of
        cirrhosis, are not excluded from participation in the study if Alanine aminotransferase
        (ALT) and aspartate aminotransferase (AST) levels are below 2 times the upper limit of
        normal on a consistent basis during the 2 months preceding randomization.

        12. Occult tuberculosis requiring prophylactic treatment with anti-tubercular drug(s) that
        overlaps with the patient's participation in this study.

        13. Cirrhosis of the liver based on histological criteria or clinical criteria (e.g.,
        presence of ascites, esophageal varices, spider nevi, or history of hepatic
        encephalopathy).