1. Medical use

2. Adverse effects

3. Choice of agent
    Types 

4. Mechanism of action

5. References

6. External links
    Common Phosphate Binders 

Phosphate binders are medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in people with chronic kidney failure (CKF) as they often have difficulty getting rid of the phosphates that get into their blood (i.e., the serum phosphate in chronic kidney failure is typically elevated).

Medical use

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}}

They are also used in hypoparathyroidism which presents with hypocalcemia with hyperphosphatemia.

Adverse effects

With regard to phosphate binders, aluminium-containing compounds (such as aluminium hydroxide) are the least preferred because prolonged aluminium intake can cause encephalopathy and osteomalacia. If calcium is already being used as a supplement, additional calcium used as a phosphate binder may cause hypercalcemia and tissue-damaging calcinosis. One may avoid these adverse effects by using phosphate binders that do not contain calcium or aluminium as active ingredients, such as lanthanum carbonate or sevelamer.

Choice of agent

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.^[1]

Types

• Calcium acetate/magnesium carbonate

Mechanism of action

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. Phosphate binders such as sevelamer may also be polymeric structures which bind to phosphate and are then excreted.

References

1. {{note|Lederer}} Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL: http://www.emedicine.com/med/topic1097.htm, 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|year=2007|last1=Spiegel|first1=David M.|last2=Farmer|first2=Beverly|last3=Smits|first3=Gerard|last4=Chonchol|first4=Michel}}

External links

• [https://web.archive.org/web/20050924124247/http://fosrenol.com/Consumers/Default.aspx High Phosphate Control - Official Fosrenol Homepage]
• Phosphate Binders: What Are They And How Do They Work? - American Association of Kidney Patients
• Phosphate Binders - National Kidney Foundation
• Phosphate Binders - Northwest Kidney Centers - a center that provides services for people with ESRD in the Seattle area.
• High Phosphate - Phosphorus Control - Information for healthcare professionals on the treatment and management of hyperphosphatemia

Common Phosphate Binders

• {{cite journal |doi=10.1093/ndtplus/sfr168|title=Use of magnesium as a drug in chronic kidney disease|journal=Clinical Kidney Journal|volume=5|pages=i62|year=2012|last1=Hutchison|first1=A. J.|last2=Wilkie|first2=M.}}
• [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

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