Chronic kidney disease (CKD) is a general term for a set of heterogeneous disorders that negatively affect the function and structure of the kidney. Because of the role of the kidney in many of the body’s regulatory functions, CKD is accompanied by a wide range of comorbidities and complications. Hyperphosphatemia is a common complication of CKD. Although there are treatments for hyperphosphatemia, physicians, patients, and healthcare systems are concerned over some aspects of these treatments. Compliance, safety issues, and tightening healthcare budgets have resulted in increased scrutiny of the effectiveness and tolerability of these agents. The Current Treatment: Hyperphosphatemia content examines the management of patients on dialysis and/or with mid- to late-stage CKD from the perspective of 100 nephrologists. This content provides a detailed and expanded analysis of the dynamics of the hyperphosphatemia therapy market, practice patterns and physician attitudes and perceptions, and the current and projected use of established therapies such as Renvela, Renagel, PhosLo, PhosLyra, and Fosrenol, as well as new therapies such as the iron-based phosphate binders Velphoro and Auryxia. Also included are discussions of patients' persistency and compliance with current therapies and the drivers and obstacles to their uptake.

Questions Answered:

  • The majority of the CKD population suffer from hyperphosphatemia. What percentage of hyperphosphatemia patients in hemodialysis (HD), peritoneal dialysis (PD), or chronic kidney disease-nondialysis (CKD-ND) have severe, moderate, or mild hyperphosphatemia? What percentage of patients are diagnosed with severe, moderate, or mild hyperphosphatemia? What percentage of HD, PD, and CKD-ND patients receive pharmacologic treatment for hyperphosphatemia?
  • Sevelamer-based phosphate binders (Renvela/Renagel) and calcium acetate formulations (PhosLo, PhosLyra) are commonly used to treat hyperphosphatemia in dialysis patients. These agents continue to dominate the hyperphosphatemia market, making it difficult for novel iron-based agents such as Velphoro and Auryxia to gain uptake in early lines of therapy. What is the reported patient share of phosphate binders? How does this share differ between HD, PD, and CKD-ND? Which phosphate binders have the highest and lowest percentage of patients on therapy, and how does it differ by late-stage CKD and dialysis patient populations? What are the most-prescribed first-, second-, and third-line therapies for hyperphosphatemia? What percentage of patients progress from first-line treatment to second-line treatment? What percentage of surveyed nephrologists anticipate increasing their use of phosphate binders six months from now?
  • Disease severity influences the treatment of hyperphosphatemia. At what serum phosphorus level do nephrologists typically initiate phosphate binder therapy in dialysis and nondialysis populations? Which phosphate binders are typically prescribed to patients with severe hyperphosphatemia? Do physicians try to keep their hyperphosphatemic patients’ phosphorus levels within a target range? Does this consideration differ between CKD-ND and dialysis? What is the acceptable target range for phosphorus levels in these populations?
  • More-tolerable agents are needed to treat hyperphosphatemia, although safety and tolerability are not important drivers of prescribing. What are the most important clinical and nonclinical factors that drive prescribing of phosphate binders? How does an agent’s efficacy influence prescribing? How important is the drug’s price to prescribers? Why do nephrologists typically switch or discontinue therapies?
  • Only half of the surveyed nephrologists who have prescribed both Velphoro and Auryxia view them as unique from each other. How do nephrologists differentiate the two iron-based phosphate binders? Why do some physicians not differentiate between the two phosphate binders?

Scope:

  • Markets covered: United States
  • Methodology: Survey of 73 nephrologists and 27 internal medicine physicians with a nephrology subspecialty, completed in February 2017.
  • Indication coverage: Hyperphosphatemia
  • Key drugs covered: Auryxia (ferric citrate), Fosrenol (lanthanum carbonate), PhosLo (calcium acetate), PhosLyra (calcium acetate), Renvela (sevelamer carbonate), Renagel (sevelamer hydrochloride), Tums (calcium carbonate), Velphoro (sucroferric oxyhydroxide)
  • Key companies mentioned: Fresenius Medical Care North America, Genzyme, Sanofi, Shire, Vifor

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