The Role of Phosphate Binders in the Treatment of Chronic Kidney Disease

In end stage chronic kidney disease hyperphosphatemia is an unavoidable consequence present in the majority of dialysis patients. Existing dialysis prescription pattern and dietary restriction of phosphate are not enough to uphold serum phosphate levels within the suggested range so that the majority of dialysis patients necessitate oral phosphate binders. Regrettably, conventional phosphate binders are linked with a range of limitations and side effects and are not consistently effective. Eventhough phosphate binders are known to reduce serum phosphate levels in patients, it remains indecisive whether they improve clinical outcomes. Calcium based salts are effective, economical and most widely used, but nowadays their connection with hypercalcemia and vascular calcification is a matter of concern. Though highly efficient Aluminium-containing agents are no longer widely used because of well known and proven toxicity. The non calcium based phosphate binders- Sevelamer hydrochloride and lanthanum carbonate is associated with fewer adverse effects. The restricting factors for its wider use is the large pill burden and high cost. In addition, there is a debatable fact about the efficacy of sevelamer as a monotherapy in lowering phosphate to target levels in severe hyperphosphatemic conditions. The main reasons which contributes to poor medication adherence are the large pill burden and adverse effects of the phosphate binders.