Optimal use of phosphate binders in chronic kidney disease.
BACKGROUND
Hyperphosphatemia is one of the major factors associated with the development of vascular calcification in patients with chronic kidney disease (CKD). Since phosphate is retained in such patients, pharmacological treatment and other measures are necessary to control hyperphosphatemia. Several phosphate binders (calcium salts, magnesium salts, non-calcium-based binders and aluminium) are available for the treatment of hyperphosphatemia. Nevertheless, none of the above mentioned agents has shown an overall superiority over others, while potency and side effects are quite variable among them creating difficulties in choosing the optimal drug for each patient.


METHODS
The authors discuss the disturbed phosphate metabolism, the available phosphate binders, as well as the general therapeutic principles of treating hyperphosphatemia in CKD patients. The literature used for this review had been retrieved from PubMed and covers a large number of original and retrospective studies as well as prospective cohort studies, meta-analyses and international clinical guidelines.


CONCLUSIONS
Lowering serum phosphate levels in CKD patients may potentially have a positive impact on cardiovascular morbidity and mortality. Factors that should be taken into consideration when selecting a specific drug include CKD stage, cardiovascular disease, severity of secondary hyperparathyroidism, concomitant medications, life expectancy and patient compliance. Therefore, when selecting a specific phosphate binder, individualisation is mandatory.
Sismanoglion - A. Fleming General Hospital, Department of Nephrology , 15232 Athens , Greece +0030 210 6859562 ; +0030 2610 994424 ; msonikian@gmail.com.
Makrouhi
M
Sonikian
Evangelos
E
Papachristou
Dimitrios S
DS
Goumenos
D000536:Aluminum Hydroxide / Q000008:administration & dosage / Q000627:therapeutic use; D017610:Calcium Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D007811:Lanthanum / Q000008:administration & dosage / Q000627:therapeutic use; D008274:Magnesium / Q000008:administration & dosage / Q000627:therapeutic use; D010349:Patient Compliance; D010710:Phosphates / Q000097:blood*; D011073:Polyamines / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D000069603:Sevelamer; D061205:Vascular Calcification / Q000209:etiology / Q000517:prevention & control*
D017610:Calcium Compounds; D002614:Chelating Agents; D010710:Phosphates; D011073:Polyamines; C005479:magnesium carbonate; C119467:lanthanum carbonate; D000536:Aluminum Hydroxide; D007811:Lanthanum; D000069603:Sevelamer; D008274:Magnesium