Oral phosphate binders for the management of serum phosphate levels in dialysis patients.
Hyperphosphataemia is an inevitable consequence of end stage chronic kidney disease and is present in the majority of dialysis patients. Hyperphosphataemia is statistically associated with increased cardiovascular mortality among dialysis patients. Dietary restriction of phosphate and current dialysis modalities are not sufficiently effective to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders. However, benefits of achieving the recommended range have yet to be demonstrated prospectively. Unfortunately, conventional phosphate binders are not reliably effective and are associated with a range of limitations and side effects. Aluminium containing agents are highly efficient but no longer widely used because of well-established and proven toxicity. Calcium-based salts are inexpensive, effective and most widely used but there is now concern about their association with hypercalcaemia and vascular calcification. Sevelamer hydrochloride and lanthanum carbonate are non-aluminium, calcium-free phosphate binders. They are effective and reasonably well tolerated, but still do not control phosphate levels in all patients. Patient education programmes have been shown to be a useful and effective method of improving achievement of serum phosphate targets.
Mohammed
Ismail
I
Wythenshawe Hospital Dialysis Unit, South Manchester University Hospital, Manchester, M23 9LT, UK.
Hutchison
Alastair J
AJ
D000085:Acetates / Q000627:therapeutic use; D000284:Administration, Oral; D000536:Aluminum Hydroxide / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology; D054559:Hyperphosphatemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007811:Lanthanum / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D009398:Nephrology / Q000379:methods / Q000639:trends; D010353:Patient Education as Topic; D010758:Phosphorus / Q000097:blood; D011073:Polyamines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D000069603:Sevelamer; D016896:Treatment Outcome
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; C005479:magnesium carbonate; D010758:Phosphorus; C119467:lanthanum carbonate; D000536:Aluminum Hydroxide; D007811:Lanthanum; D000069603:Sevelamer; D002119:Calcium Carbonate; D008274:Magnesium; C120662:calcium acetate