Phosphate binder usage in kidney failure patients.
Phosphorus binders are used in patients with kidney failure because of the incomplete removal of phosphorus with dialysis and the inability to exclude phosphorus from the diet. Aluminium was the initial phosphorus binder used, but was replaced by calcium-containing binders because of the development of aluminium toxicity. Calcium-based binders have been the mainstay of therapy for many years, but recent investigations have pointed to increased rates of vascular calcification in patients taking calcium-containing binders. For this reason, alternative agents have been developed. Sevelamer (Renagel), GelTex Pharmaceuticals Inc.) is a polymer which has been found to effectively bind phosphorus. It has resulted in a decreased rate of vascular calcification compared to calcium-containing binders. Other agents under development include lanthanum carbonate and iron-complex preparations. Further research will likely concentrate on identifying binders that bind phosphate more efficiently, have minimal gastrointestinal side effects and provide other benefits to dialysis patients.
Bleyer
Anthony J
AJ
Section on Nephrology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. ableyer@wfubmc.edu
D000085:Acetates / Q000627:therapeutic use; D017607:Aluminum Compounds / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000627:therapeutic use; D017610:Calcium Compounds; D002986:Clinical Trials as Topic; D004852:Epoxy Compounds / Q000627:therapeutic use; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D007656:Ketoglutaric Acids / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000378:metabolism; D007811:Lanthanum / Q000627:therapeutic use; D010710:Phosphates / Q000097:blood / Q000378:metabolism*; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use; D006435:Renal Dialysis; D000069603:Sevelamer
D000085:Acetates; D017607:Aluminum Compounds; D017610:Calcium Compounds; D004852:Epoxy Compounds; D058085:Iron Compounds; D007656:Ketoglutaric Acids; D010710:Phosphates; D011073:Polyamines; D011095:Polyethylenes; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002119:Calcium Carbonate; C120662:calcium acetate