Renvela vs Auryxia

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Introduction

Patients with chronic kidney disease (CKD) on dialysis often grapple with a high phosphate level in their blood, which can lead to serious health issues. Renvela and Auryxia are two drugs that help manage these levels by binding to dietary phosphates in the gastrointestinal tract and preventing their absorption into the body. Renvela is a calcium-free metal cation binder, ensuring it doesn't contribute to an excess of calcium and making it suitable for patients who need to control their intake of this mineral. On the other hand, Auryxia is an iron-based phosphate binder that also provides supplemental iron therapy, as patients on dialysis frequently suffer from conditions like anaemia due to decreased production of red blood cells by the kidneys.

What is Renvela?

Sevelamer (the generic name for Renvela) and Ferric Citrate (Auryxia's generic name) are two different types of phosphate binders often prescribed to patients with chronic kidney disease. Sevelamer was first approved by the FDA in 1998, marking it as an important evolution from calcium-based phosphate binders. It works by binding dietary phosphorus in the digestive tract and reducing its absorption into the body. Sevelamer is typically prescribed for patients undergoing dialysis due to end-stage renal disease.

On the other hand, Ferric citrate also binds dietary phosphorus but has a dual function—it can also increase iron stores in these patients who commonly have iron deficiency. This unique quality makes Auryxia a preferred choice for some practitioners while considering patient-specific factors. Both drugs have their own side effect profiles; however, sevelamer’s non-calcium and non-aluminum structure means that it does not contribute to secondary problems such as vascular calcification or aluminum toxicity—a noteworthy advantage over other phosphate binders.

What conditions is Renvela approved to treat?

Renvela and Auryxia are both approved for the treatment of different types of kidney disease:

  • Renvela is used to lower high blood phosphate (phosphorus) levels in patients who are on dialysis due to severe kidney disease. Dialysis removes some phosphate from your blood, but it is difficult to remove enough to keep your phosphate levels balanced.

  • Auryxia is used for controlling serum phosphorus levels in adults with chronic kidney disease (CKD) on dialysis. It also treats iron deficiency anemia in adults with CKD not on dialysis.

How does Renvela help with these illnesses?

Renvela helps manage high phosphorus levels in people with chronic kidney disease by binding to dietary phosphate, making it unavailable for absorption in the digestive tract. This action effectively reduces the amount of phosphate that gets into the bloodstream. Phosphorus is a mineral found in many foods and is important for bone health, energy production, and cell function among other things. However, when kidneys are not functioning properly they may struggle to remove excess phosphorus from the blood which can lead to complications such as heart disease and bone disorders. By limiting this excess phosphorous intake, Renvela assists patients with managing their condition and stabilizing their mineral balance.

What is Auryxia?

Auryxia, with the generic name ferric citrate, is primarily used to lower phosphate levels in patients who have kidney disease and are on dialysis. It functions as an iron-based phosphate binder that stops your body from absorbing too much phosphate from the food you consume. Auryxia was first approved by the FDA in 2014 and it also has an additional benefit of increasing serum iron levels and reducing the need for IV iron therapy.

Unlike Renvela (sevelamer), which does not contain any metal elements, Auryxia provides a source of dietary iron while concurrently binding to dietary phosphates resulting in decreased absorption. Its side-effect profile slightly differs from that of Renvela – common side effects can include diarrhea or constipation, nausea, abdominal pain or discomfort but it typically does not cause severe metabolic acidosis unlike sevelamer compounds like Renvela. Due to its dual action role on both hyperphosphatemia and iron deficiency anaemia often seen in dialysis patients, many find Auryxia beneficial over traditional non-iron based phosphate binders such as Renvela.

What conditions is Auryxia approved to treat?

Auryxia is an iron-based phosphate binder approved for the treatment of:

  • Hyperphosphatemia in adults with chronic kidney disease who are on dialysis.
  • Iron deficiency anemia in adults with chronic kidney disease not on dialysis.

It is designed to limit the absorption of dietary phosphates, and uniquely, it also provides supplemental iron as part of its action - a double benefit that Renvela does not offer.

How does Auryxia help with these illnesses?

Ferric citrate, the active ingredient in Auryxia, acts as an iron-based phosphate binder and plays roles in many processes within the body including enhancing iron absorption, increasing ferritin levels and decreasing serum phosphate concentrations. These actions are particularly beneficial for patients with chronic kidney disease (CKD) on dialysis who often struggle with hyperphosphatemia - high levels of phosphates in their blood. Auryxia works by binding to dietary phosphate in the digestive tract, thereby reducing its absorption into the bloodstream. This action not only helps control serum phosphorus levels but also contributes to a rise in stored iron levels which can be beneficial since these patients commonly have anemia due to iron deficiency. While Renvela is also prescribed for managing hyperphosphatemia related to CKD on dialysis, it lacks this additional benefit of improving iron stores seen with Auryxia. Therefore, Auryxia may be chosen when a patient does not respond well or has contraindications for other standard phosphate binders such as sevelamer carbonate (Renvela), or it might be combined with them depending on individual needs.

How effective are both Renvela and Auryxia?

Both sevelamer (Renvela) and ferric citrate (Auryxia) have established histories of success in treating patients with chronic kidney disease on dialysis, and they were initially approved by the FDA only a few years apart. Since they act to bind different compounds in the gut, they may be prescribed under different circumstances. The effectiveness of Sevelamer and Ferric Citrate in managing hyperphosphatemia was directly studied in multiple clinical trials; both drugs exhibit similar efficacy as phosphate binders reducing serum phosphorous levels while also displaying promising safety profiles.

A 2007 meta-analysis showed that sevelamer is effective at controlling serum phosphorus levels without causing an increase in calcium intake, thus avoiding the risk of vascular calcification associated with other phosphate binders. Further, it has been reported to reduce cholesterol levels which might be beneficial for cardiovascular health among dialysis patients.

On the other hand, a 2015 review indicated that ferric citrate seems to be quite effective at not just controlling phosphorous but also maintaining iron stores due its iron component - an added benefit considering many CKD patients suffer from iron deficiency anemia. However, Auryxia can darken stools due to its iron content which can complicate gastrointestinal symptom assessment.

Sevelamer generally remains a first-line treatment choice due to its proven track record and non-calcium based action whereas ferric citrate is often considered for those needing additional help managing their iron status or when alternative options are necessary.

abstract image of a researcher studying a bottle of drug.

At what dose is Renvela typically prescribed?

Oral dosages of Renvela for adults with chronic kidney disease on dialysis start at 800-1600 mg three times daily with meals. However, the dosage is often adjusted based on serum phosphorus levels. For Auryxia, the starting dose is typically 210 mg orally three times a day with meals. Similar to Renvela, this dosage can be increased after several weeks if there is no adequate response in lowering serum phosphate levels. The maximum recommended total daily dose of Auryxia should not exceed 2,520 mg in any case.

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At what dose is Auryxia typically prescribed?

Auryxia treatment for patients with chronic kidney disease on dialysis typically starts at a dosage of 210 mg three times a day with meals. Depending on the individual's response to treatment and their serum phosphorus levels, this dose can then be increased in increments of 1 to 2 tablets per meal (i.e., an increase of three to six tablets per day) every week as needed. The maximum recommended daily dose is 12 tablets (2,520 mg). If there is no sufficient decrease in serum phosphorus levels after two to four weeks at the maximum dosage, it may be necessary to reassess the patient's adherence to therapy or diet, reevaluate other phosphate binders, or consider adding additional therapies.

What are the most common side effects for Renvela?

Common side effects of Renvela may include:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Flatulence (gas)
  • Constipation

On the other hand, Auryxia can cause side effects like:

  • Diarrhea
  • Nausea
  • Constipation
  • Hyperkalemia (high levels of potassium in your blood)
  • Hypocalcemia (low calcium levels)

It is important to note that while these medications share some similar side effects, their severity and frequency can vary. Always consult with a healthcare provider to understand which medication might be best for you based on your individual health circumstances.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Renvela?

While both Renvela and Auryxia are used to control high blood phosphorus levels in people with chronic kidney disease, they may cause different side effects.

With Renvela, some of the rare but serious side effects might include:

  • Severe constipation or stomach pain
  • Signs of an allergic reaction including hives; difficulty breathing; swelling of your face, lips, tongue, or throat

On the other hand, Auryxia can sometimes lead to the following severe reactions:

  • Allergic reactions such as skin rash, itching/swelling (especially on the face/tongue/throat), severe dizziness or trouble breathing
  • Signs of high potassium level - muscle weakness/paralysis/slow irregular heartbeat
  • Unusual tiredness
  • Sudden/unexpected weight gain
  • Swelling hands/ankles/feet
  • Shortness of breath

In any case if you experience these symptoms while taking either drug please contact a healthcare professional immediately.

What are the most common side effects for Auryxia?

Auryxia, a phosphate binder like Renvela, also has its own unique set of side effects that potential users should be aware of. These include:

  • Diarrhea or constipation
  • Nausea, vomiting, stomach discomfort or loss of appetite
  • Changes in the color of stools to a darker shade
  • Coughing or shortness of breath
  • Muscle spasms or weakness
  • Fast heartbeat and related sensations such as palpitations
  • Hypersensitivity reactions including rash and itching
  • Sleep problems such as insomnia Additionally, Auryxia may lead to an increase in blood pressure for some patients. It's important to monitor your health closely while on this medication and report any significant changes to your doctor promptly.

Are there any potential serious side effects for Auryxia?

Auryxia, while generally considered safe, can sometimes result in certain severe reactions. Pay attention to the following symptoms:

  • Unexpected allergic reactions like rash, hives or itching.
  • Difficulty breathing or swallowing due to anaphylaxis.
  • Swelling of your throat, face and even limbs
  • Sharp chest pain combined with shortness of breath indicating heart problems
  • Dark stools or vomit that appears coffee-colored - this could be a sign of gastrointestinal bleeding
  • Severe nausea, vomiting or diarrhea
  • Unusual changes in mood or behavior including confusion and irritability

These symptoms may indicate serious side effects. If you experience any such symptom after taking Auryxia, seek immediate medical attention.

Contraindications for Renvela and Auryxia?

Renvela and Auryxia, like all medications for managing kidney disease, may cause discomfort or complications in some people. If you notice any severe side effects such as stomach pain, vomiting, constipation, diarrhea or an unusual change in appetite after starting these medications, please seek immediate medical attention.

Neither Renvela nor Auryxia can be taken if you are currently using other phosphate binders unless explicitly advised by your physician due to the risk of excess phosphorus removal from the body. Always inform your healthcare provider about which medications you are taking; other phosphate binders will require a period of clearance from your system to prevent harmful interactions with Renvela and Auryxia.

It's also worth noting that both drugs should not be used if you have low levels of phosphorus (hypophosphatemia) or difficulty swallowing. Furthermore, patients who have had a gastric bypass surgery or similar stomach operation should exercise caution when taking these medicines.

How much do Renvela and Auryxia cost?

For the brand name versions of these drugs:

  • The price for 90 tablets of Renvela (800 mg) averages around $725, which works out to approximately $24-$48/day, depending on your dose.
  • The price for 30 tablets of Auryxia (210 mg iron equivalent) is about $1,142, working out to roughly $38/day.

Thus if you are in the higher dosage range for Renvela (i.e., 2400mg/day or higher), then branded Auryxia becomes less expensive on a per-day treatment basis. Remember though that cost should not be the primary consideration when determining which drug is right for you.

Currently there are no generic equivalents available for either Renvela (sevelamer carbonate) and Auryxia (ferric citrate). Costs can vary based on location and pharmacy so it's always worth shopping around. Also consider any insurance coverage you may have as this will influence your final out-of-pocket expense.

Popularity of Renvela and Auryxia

Sevelamer, also known by its brand name Renvela, was estimated to have been prescribed to about 1.2 million people in the US in 2020. Sevelamer accounted for just over 60% of phosphate binder prescriptions in the US, which are used for patients with chronic kidney disease on dialysis to prevent dangerous levels of phosphorus accumulating in their blood. The prevalence of sevelamer has been generally increasing since its approval by the FDA in 1998.

Ferric citrate, including brand versions such as Auryxia, was prescribed to approximately 150,000 people in the USA during 2020. In the US ferric citrate accounts for just under 10% of phosphate binder prescriptions and is also approved as an iron supplement for adults suffering from chronic kidney disease not on dialysis. Since receiving FDA approval for both indications between 2014-2017, use of ferric citrate has seen steady growth.

Conclusion

Both Renvela (sevelamer carbonate) and Auryxia (ferric citrate) have been proven to be effective in managing high phosphorus levels in patients with chronic kidney disease who are on dialysis. They function by binding dietary phosphate in the gut, preventing its absorption into the bloodstream. The choice between these two drugs often depends on individual patient needs and circumstances.

Renvela is a non-calcium, metal-free phosphate binder that doesn't contribute to the calcium load of patients, hence it's often considered for those at risk of hypercalcemia or vascular calcification. On the other hand, Auryxia not only binds dietary phosphate but also delivers an iron source which could be beneficial for some patients with iron-deficiency anemia.

Both medications are available as generics, offering cost-effective options to many patients. Initially starting either drug may require a period of dose adjustment under medical supervision to achieve optimal phosphorus control while minimizing side effects.

In terms of side effects profiles, both can cause gastrointestinal issues such as constipation or diarrhea among others; however, Auryxia might lead to discolored stools due to its iron content but generally this is harmless and expected. For both drugs, once treatment starts it's important for patients' blood parameters including serum phosphorus levels and potentially hemoglobin/iron profile (particularly if using Auryxia), among others should be closely monitored by their healthcare provider regularly.