Oral Phosphate Binders in Patients with Kidney Failure.
The three key elements in the management of elevated serum phosphate are dietary restriction, drug treatment using oral phosphate binders (see Figure 1), and adequate dialysis. Dietary phosphate restriction is impractical for many patients, and a general decline in home cooking skills often means that supermarkets are indirectly responsible for patients’ phosphate, sodium, and potassium intake.
The role of calcium and non calcium-based phosphate binders in chronic kidney disease GRAHAME J ELDER1,2 and JACQUELINE CENTER2,3 1Department of Renal Medicine, Westmead Hospital, Westmead, 2Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, 3Department of Endocrinology, St Vincent’s Hospital, Darlinghurst, Australia.
Background: Dysregulated serum calcium and FGF23 are associated with increased mortality and morbidity rates in patients receiving hemodialysis. Preliminary data suggest serum calcium regulates FGF23 secretion independently of serum phosphate, parathyroid hormone, and 25-OH vitamin D. It is unclear to what extent dietary and prescription sources of calcium influence calcium and FGF23 levels.
Non-calcium-based phosphate binders were associated with a decreased risk of all-cause mortality compared with calcium-based phosphate binders in patients with chronic kidney disease. CRD commentary The review addressed a clear question supported by reproducible inclusion criteria.
Noncalcium-based phosphate binders are associated with a lower risk for all-cause mortality in patients with chronic kidney disease compared with calcium-based phosphate binders.
Phosphate binders for adults. For adults, your healthcare professional should offer a phosphate binder called calcium acetate first. If you can't take calcium acetate for any reason, they should talk to you about taking a different binder called calcium carbonate.
Calcium-containing phosphate binders are the most used and cheapest binders but have fallen out of favour because of the potential for positive calcium balance and calcium toxicity. This problem may be attenuated by newer phosphate binders such as sevelamer hydrochloride and lanthanum carbonate.