phosphate binder

These agents work by binding to phosphate in the GI tract, thereby making it unavailable to the body for absorption. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Phosphate binders may be simple molecular entities (such as magnesium, aluminium, calcium, or lanthanum salts) that react with phosphate and form an insoluble compound.

Calcium carbonate

Calcium-based phosphate binders, such as calcium carbonate, directly decrease phosphate levels by creating insoluble calcium–phosphate complexes which gets eliminated in the feces.{{Cite journal |last=Daoud |first=Kirollos |last2=Anwar |first2=Nihad |last3=Nguyen |first3=Timothy |date=2023 |title=The Role of Iron-Based Phosphate Binder in the Treatment of Hyperphosphatemia |url=http://dx.doi.org/10.37526/1526-744x.2023.50.2.140 |journal=Nephrology Nursing Journal |volume=50 |issue=2 |pages=140 |doi=10.37526/1526-744x.2023.50.2.140 |issn=1526-744X|url-access=subscription }}

Lanthanum carbonate

Non-calcium-based phosphate binders, including lanthanum carbonate, form insoluble complexes with phosphates in food, thereby reducing the amount of phosphate in the body.

Sevelamer carbonate

Sevelamer is an insoluble polymeric amine, which is protonated once in the intestines and this allows it to bind dietary phosphate. Phosphates are eliminated along with sevelamer, leading to a decrease in the body's phosphate levels.

For people with chronic kidney failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH).{{ref|Lederer}}

Calcium carbonate

• GI effects (nausea, vomiting, constipation){{Cite journal |last=Daoud |first=Kirollos |last2=Anwar |first2=Nihad |last3=Nguyen |first3=Timothy |date=2023 |title=The Role of Iron-Based Phosphate Binder in the Treatment of Hyperphosphatemia |url=http://dx.doi.org/10.37526/1526-744x.2023.50.2.140 |journal=Nephrology Nursing Journal |volume=50 |issue=2 |pages=140 |doi=10.37526/1526-744x.2023.50.2.140 |issn=1526-744X|url-access=subscription }}
• Risk of cardiovascular calcification{{Cite journal |last=Jadav |first=Paresh R. |last2=Husain |first2=S. Ali |last3=Mohan |first3=Sumit |last4=Crew |first4=Russell |date=May 2022 |title=Non calcium phosphate binders - Is there any evidence of benefit |url=https://journals.lww.com/10.1097/MNH.0000000000000796 |journal=Current Opinion in Nephrology & Hypertension |language=en |volume=31 |issue=3 |pages=288–296 |doi=10.1097/MNH.0000000000000796 |issn=1062-4821 |via=Ovid|url-access=subscription }}
• Risk of hypercalcemia

Lanthanum carbonate

• GI obstruction
• Bile duct obstruction
• Hepatic impairment
• No hypercalcemia risk

Sevelamer carbonate

• GI effects (nausea, vomiting, constipation, flatulence)
• No hypercalcemia risk

There have been limited trials comparing phosphate binders to placebo in the treatment of hyperphosphatemia in people with chronic kidney disease. When compared with people receiving calcium-based binders, people taking sevelamer have a reduced all-cause mortality.{{cite journal |last1=Patel |first1=L |last2=Bernard |first2=LM |last3=Elder |first3=GJ |title=Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials. |journal=Clinical Journal of the American Society of Nephrology |date=14 December 2015 |volume=11 |issue=2 |pages=232–244 |doi=10.2215/CJN.06800615 |pmid=26668024|pmc=4741042 }}

• Calcium acetate/magnesium carbonate

{{Reflist}}

1. {{note|Lederer}} Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL: [http://www.emedicine.com/med/topic1097.htm Hyperphosphatemia: Practice Essentials, Background, Pathophysiology], Accessed on July 14, 2005.
2. {{note|Spiegel}} {{cite journal |doi=10.1053/j.jrn.2007.08.005|pmid=17971314|title=Magnesium Carbonate is an Effective Phosphate Binder for Chronic Hemodialysis Patients: A Pilot Study|journal=Journal of Renal Nutrition|volume=17|issue=6|pages=416–22|year=2007|last1=Spiegel|first1=David M.|last2=Farmer|first2=Beverly|last3=Smits|first3=Gerard|last4=Chonchol|first4=Michel}}

• [https://web.archive.org/web/20050924124247/http://fosrenol.com/Consumers/Default.aspx High Phosphate Control - Official Fosrenol Homepage]
• [https://web.archive.org/web/20071018190326/http://aakp.org/aakp-library/Phosphate-Binders--What-Are-They-And-How-Do-They-Work-/index.cfm Phosphate Binders: What Are They And How Do They Work?] - American Association of Kidney Patients*
• [https://web.archive.org/web/20050729114056/http://www.kidney.org.uk/Medical-Info/drugs/phosinf.html Phosphate Binders] - National Kidney Foundation
• [https://web.archive.org/web/20050302034031/http://www.nwkidney.org/images/website/docs/nutrition/phosphate.htm Phosphate Binders] - Northwest Kidney Centers - a center that provides services for people with ESRD in the Seattle area.
• [https://web.archive.org/web/20070319000733/http://www.phosphoruscontrol.com/Default.aspx High Phosphate - Phosphorus Control] - Information for healthcare professionals on the treatment and management of hyperphosphatemia

• {{cite journal |doi=10.1093/ndtplus/sfr168|pmid=26069822|title=Use of magnesium as a drug in chronic kidney disease|journal=Clinical Kidney Journal|volume=5|issue=Suppl 1|pages=i62–i70|year=2012|last1=Hutchison|first1=A. J.|last2=Wilkie|first2=M.|pmc=4455824}}
• [https://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a605015.html Lanthanum] - medlineplus.org
• [https://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601248.html Sevelamer] - medlineplus.org
• [https://www.aubagio.com/?s_mcid=AUWIKI001 Sevelamer] - Renvela.com

{{Drugs for treatment of hyperkalemia and hyperphosphatemia}}

Category:Nephrology procedures