Can Ferric Pyrophosphate Citrate be an alternative to Injection in Chronic Kidney Disease (CKD) Patients?


What is Chronic Kidney Disease (CKD)?

A condition which is characterized by a gradual loss of kidney function over a certain amount of time is known as Chronic Kidney Disease (CKD) or Chronic Renal Disease. Conditions that decrease the ability of the kidneys to keep the individual healthy by filtering waste from the blood and damaging the kidneys are included in the effects of chronic kidney disease.

Wastes can build up to high levels in the human blood and make an individual sick if kidney disease worsens.

What causes Chronic Kidney Disease (CKD)? 

Poor nutritional health, weak bones, and low blood count leading to anaemia and high blood pressure are some of the complications that individuals might develop due to chronic kidney disease. The risk of having blood vessel and heart disease increases due to kidney diseases. The risk of chronic kidney disease is high for millions of people, and most adults have already received a diagnosis.

As kidney disease advances and culminates in kidney failure, sustaining life will necessitate dialysis or a kidney transplant.

The leading cause of death among individuals with CKD is heart disease.

Hypertension, high blood pressure, and diabetes account for two-thirds of chronic kidney disease cases.

When the blood sugar level of an individual remains two types of diabetes occur. Mini organs in the human body might get damaged including the eyes, nerves, blood vessels, heart and kidneys due to unmanaged blood sugar levels over a period of time. High blood pressure can be caused due to chronic kidney disease.

When the human blood pressure against the walls of the blood vessels increases it leads to high blood pressure. It can be the leading cause of chronic kidney disease, major heart attacks and strokes if left uncontrolled or poorly controlled.

Autoimmune disease, kidney and urinary tract abnormalities before birth inherited disease and glomerulonephritis are some of the other conditions that can affect the kidney. Inflammation and damage to the kidney’s filtering units are caused by a group of diseases known as glomerulonephritis. In the most common type of kidney disease, these disorders come in the third position.

Large cysts are formed in the kidneys and damage the surrounding tissues due to polycystic kidney disease or PKD, which is a common inherited disease. The normal outflow of urine might get prevented by a narrowing of the urinary tract and cause the urine to flow back up to the kidney which can cause damage to the kidneys and might infect the area. These malfunctions might occur before birth in the mother’s womb which can lead to severe complications.

The turning against the immune system and the body’s different systems is known as an autoimmune disease which results in the inflammation of the small blood vessels that filter waste in the human kidney.

One such example of autoimmune disease is Lupus Nephritis. Age doesn’t matter for getting affected by chronic kidney disease.

Some of the conditions in which the risk factors increase for developing a kidney Disease are:

  • When an individual belongs to a population group with high levels of blood pressure or diabetes like Americans, or Indians, then the risk of kidney disease increases.
  • Elder people have a high risk of kidney Disease.
  • When an individual has a family history of kidney failure the risk of kidney disease becomes high.
  • When an individual has high blood pressure the risk of kidney disease increases.
  • When an individual has diabetes the risk factor for kidney disease is high.

The need for urinating more often, especially at night, dry and itchy skin, puffiness around the eyes especially in the morning, swollen feet and ankles, muscle crimping at night, trouble sleeping, a poor appetite, trouble in concentration, and a feeling of tiredness and having less energy are some of the symptoms that might be notified when an individual has chronic kidney disease.

However serious symptoms are often not noticeable until kidney disease advances in most cases.

Injection therapy for anaemia in chronic kidney disease (CKD)

Given through a syringe under the skin subcutaneously, injections are quite effective for the treatment of anaemia which is caused due to chronic kidney disease. Although in the case of anaemia, it might take a few weeks before the human body begins to produce more red blood cells, injection treatments allow the medication to reach the bloodstream more quickly than oral medications.

Injections are effective for treating anaemia caused by chronic kidney disease and are administered subcutaneously. They work more quickly than oral medications, but it may take several weeks before the body produces more red blood cells. Successful injection treatment can reduce the need for blood transfusions and other intrusive treatments. However, injection treatments have potential side effects and may increase mortality in patients with cancer who also have chronic kidney disease.

The need and frequency for blood transfusions and other intrusive treatment options for anaemia will be reduced with successful injection treatment. Though the total duration of the injection treatment might only take a few minutes, it is much more effective than oral medications.

However, injection treatments might have a large number of side effects:

  • Fainting, 
  • Speech difficulties, 
  • Confusion, 
  • Breathing difficulties, 
  • Chest pain, 
  • High blood pressure, 
  • Seizures, 
  • Loss of balance or coordination, 
  • Numbness or weakness, 
  • Severe skin reactions, 
  • Serious allergic reactions, 
  • Depression, 
  • Sleeping difficulties, 
  • Cold & cough, 
  • Fever, Muscles spasms, 
  • Weight loss,
  • Soreness of the mouth,
  • Headaches, 
  • Vomiting, 
  • Nausea,
  • Vision loss, 
  • Dizziness, 
  • Leg and chest pain, and 
  • Hypertension

The mortality is also increased due to injection therapy for chronic kidney disease in patients with cancer.

Ferric Pyrophosphate Citrate for the treatment of CKD patients

In patients with dialysis-dependent chronic kidney disease, ferric pyrophosphate citrate is an iron replacement product that is used to treat iron deficiency anaemia which is caused by the lack of iron in the blood. This is generally injected into the dialysis solution which is channelized into the bloodstream of a patient with chronic kidney disease who is dependent on dialysis. Dialysis is a faster way for the injection or the solution to reach the bloodstream and act accordingly.

Ferric pyrophosphate citrate is usually available in the market in the form of powder and solution. A doctor’s prescription is always required while buying the medicine. It is effective to prevent anaemia in patients with chronic kidney disease dependent on dialysis.

A check should be maintained by the doctor on a regular basis to make sure that the medicine is working properly and the progress should be noted. Ferric pyrophosphate citrate is a better alternative than injections due to its better effectiveness and the low range of severe side effects due to its usage.

Anaphylaxis is a serious allergic reaction that might be caused due to the usage of ferric pyrophosphate citrate solution. Ferric pyrophosphate citrate is made from iron (III) pyrophosphate and citric acid.

The doctor should be informed about allergic reactions or any unusual reactions to any medicines that have occurred to the patient before he prescribes Ferric pyrophosphate citrate as a medication to be added to the dialysis solution. The potential risk should be weighed against the potential benefits before the doctor prescribes this medicine to a patient.

No medical test has been confirmed to assure about the risks that are present in the usage of ferric pyrophosphate citrate solution while dialysis in pregnant or breastfeeding women. The doctor should be also concerned with the drug reactions that might occur before suggesting this medication to the patient. The iron stores of the body are drastically replenished once the ferric pyrophosphate citrate solution along with the dialysis solution is injected into the patient’s body.


What are the main causes of chronic kidney disease?

The main causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, interstitial nephritis, polycystic kidney disease, and obstructive nephropathy. Other factors that can contribute to chronic kidney disease include autoimmune diseases, recurrent kidney infections, and prolonged use of certain medications or exposure to toxins.

  1. Which people are at high risk of acquiring chronic kidney disease?

People with a higher risk of developing chronic kidney disease (CKD) include those with a family history of kidney disease, individuals with diabetes or high blood pressure, older adults, and those with a history of kidney infections or kidney stones. Other risk factors include obesity, smoking, and certain medical conditions such as autoimmune diseases or chronic infections. People who have a history of kidney disease in their family or who have any of these risk factors should talk to their healthcare provider about getting regular kidney function tests to monitor their kidney health.

  1. What are the common symptoms of chronic kidney disease?

The need for urinating more often, especially at night, dry and itchy skin, puffiness around the eyes especially in the morning, swollen feet and ankles, muscle crimping at night, trouble sleeping, a poor appetite, trouble in concentration, and a feeling of tiredness and having less energy are some of the symptoms that might be notified when an individual has chronic kidney disease. However serious symptoms are often not noticeable until kidney disease advances in most cases.

  1. Is ferric pyrophosphate citrate harmful?

An unborn baby might get harmed due to the usage of ferric pyrophosphate. Effective birth control should be used to prevent a woman from getting pregnant while the dosage is ongoing and a gap of at least 2 weeks should be ensured after the last dosage before safe conceiving.

  1. How is ferric pyrophosphate made?

Iron (III) phosphate and Iron (III) metaphosphate are mixed and then heated under oxygen with the stoichiometric ratio of 3:1 to produce anhydrous iron (III) pyrophosphate. Iron (III) nitrate nonahydrate is made to react with phosphoric acid in order to prepare the reactants.

  1. What are the possible side effects of using injections to treat chronic kidney disease?

Erythropoietin-stimulating agents (ESAs): These injections stimulate the production of red blood cells and can cause high blood pressure, blood clots, and an increased risk of heart attack or stroke.

Iron supplements: Injections of iron supplements may cause nausea, vomiting, and abdominal pain.

Parathyroid hormone (PTH) analogues: These injections help regulate calcium and phosphorus levels in the blood and can cause joint pain, headaches, and nausea.

Calcimimetics: These injections also help regulate calcium and phosphorus levels and can cause nausea, vomiting, and diarrhoea.



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