From the Guidelines
Sevelamer is the most effective phosphate binder for managing hyperphosphatemia, particularly in patients with chronic kidney disease (CKD) stages 3 to 5, due to its ability to control serum phosphorus levels without increasing the risk of hypercalcemia or arterial calcifications 1.
Key Points
- Sevelamer has been shown to be effective in lowering serum phosphorus concentrations in children with CKD, with a significant decrease in LDL cholesterol levels and a lower incidence of hypercalcemia compared to calcium-based phosphate binders 1.
- The use of sevelamer in adult patients with CKD stages 3 to 5 and 5D has been associated with a reduced progression of arterial calcifications compared to patients receiving calcium-based phosphate binders 1.
- Current evidence suggests that treatment should focus on patients with overt hyperphosphatemia, rather than maintaining normal serum phosphate levels in patients not receiving dialysis 2, 3.
- The choice of phosphate binder should be determined by patient preference, compliance, comorbid illnesses, side effects, cost, and the ability to control serum phosphorus levels while maintaining the desired calcium-phosphorus product 4.
Phosphate Binder Comparison
- Calcium-based phosphate binders, such as calcium carbonate and calcium acetate, are effective in controlling serum phosphorus levels but may increase the risk of hypercalcemia and arterial calcifications 1, 4.
- Aluminum-containing phosphate binders should be reserved for patients with serum phosphorus greater than 7.0 mg/dL and only for short-term therapy due to the potential for neurotoxicity and osteomalacia 4.
- Lanthanum carbonate is an alternative calcium- and aluminum-free phosphate binder that has been shown to be effective in controlling serum phosphorus levels 1.
From the Research
Phosphate Binders for Hyperphosphatemia Management
The management of hyperphosphatemia, a condition characterized by elevated levels of phosphate in the blood, is crucial for patients with kidney dysfunction. Several phosphate binders are available, each with its own set of benefits and drawbacks.
- Calcium-based phosphate binders: These are often the first line of treatment due to their low cost, but they can lead to hypercalcemia, positive calcium balance, and progression of cardiovascular calcification 5, 6, 7, 8.
- Non-calcium-based phosphate binders: Sevelamer hydrochloride and Lanthanum carbonate have been shown to be effective and safe, but they are more expensive than calcium-based binders 5, 6, 7, 8.
- Iron-based phosphate binders: Ferric citrate and sucroferric oxyhydroxide are newer options that can lower phosphate levels while providing an iron source, making them a valuable option for patients with iron deficiency 8, 9.
Effectiveness and Safety of Phosphate Binders
The effectiveness of phosphate binders can vary, with some studies suggesting that Sevelamer hydrochloride may be more effective than calcium acetate or Lanthanum carbonate 6. However, the safety profiles of these binders also differ, with calcium-based binders carrying a risk of hypercalcemia and vascular calcification, while non-calcium-based binders may have a lower risk of these adverse effects 5, 6, 7, 8.
Considerations for Phosphate Binder Selection
When selecting a phosphate binder, it is essential to consider the individual patient's needs and health status, as well as the potential risks and benefits of each binder 5, 6, 7, 8, 9. The choice of phosphate binder should be individualized, taking into account factors such as cost, efficacy, and safety profile.