The effect of ferric citrate hydrate on fibroblast growth factor 23 and platelets in iron deficiency anemia, both with and without chronic kidney disease

According to a recent study, irrespective of chronic kidney disease (CKD) status, iron replacement using ferric citrate hydrate (FC) reduced high levels of C-terminal fibroblast growth factor 23 (cFGF23) and restored increased platelet (PLT) counts for individuals suffering from iron deficiency anemia (IDA). This research findings were published in the journal, Clinical and Experimental Nephrology. 
In a randomized, 24-week clinical trial, a total of seventy-three patients suffering from chronic kidney disease not requiring dialysis and CKD complicated by iron deficiency anemia with hemoglobin levels between 8.0 and 11.0 g/dL, and serum ferritin levels below 50 ng/mL for CKD and below 12 ng/mL for non-CKD, were randomly assigned in a 1:1 ratio to receive either ferric citrate hydrate-high (1000 mg: ≈ 240 mg elemental iron per day) and ferric citrate hydrate-low (500 mg: ≈ 120 mg elemental iron per day). Patients were divided into two groups: FC-low (CKD n = 21, non-CKD n = 15) and FC-high (CKD n = 21, non-CKD n = 16). Treatment was discontinued if adequate iron replacement was achieved by eight weeks.
Despite CKD status, FC increased transferrin saturation and serum ferritin, with no impact on intact FGF23 or serum phosphorus, but a decrease in cFGF23. The FC-low group showed median changes in cFGF23 from baseline to week 8 of -58.00 RU/mL in CKD and -725.00 RU/mL in non-CKD. The FC-high group had median changes of -66.00 RU/mL in CKD and -649.50 RU/mL in non-CKD. By the eighth week, FC treatment successfully normalized PLT levels in all patients who had high PLT at the beginning (>35.2 × 104/µL; FC-low: one CKD, eight non-CKD; FC-high: three CKD, eight non-CKD).
Thus, it can be concluded that iron replacement therapy with FC lowered high levels of cFGF23 and improved elevated PLT counts in individuals diagnosed with IDA, irrespective of their chronic kidney disease (CKD) status.