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Phosphate binders on iron basis: a new perspective?

O Hergesell1, E Ritz

  • 1Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany (FRG).

Kidney International. Supplement
|January 14, 2000
PubMed
Summary

New iron-based compounds show promise in managing phosphate levels for dialysis patients. These novel phosphate binders effectively reduce phosphate absorption, offering a potentially safer alternative to traditional treatments.

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Area of Science:

  • Nephrology
  • Biochemistry
  • Pharmacology

Background:

  • Patients on maintenance hemodialysis often experience a positive phosphate balance due to complex elimination kinetics during dialysis.
  • Conventional phosphate binders like calcium carbonate, calcium acetate, and aluminum compounds have significant limitations, including hypercalcemia and aluminum toxicity.
  • Recent research focuses on developing alternative phosphate binders, including iron-containing compounds.

Purpose of the Study:

  • To evaluate the efficacy of trivalent iron-containing compounds as novel phosphate binders.
  • To investigate the inhibition of net intestinal phosphate uptake using various iron salts and complex iron hydroxide compounds.
  • To assess the effectiveness and safety of a stabilized polynuclear iron hydroxide compound in uremic rats and subjects with preterminal renal failure.

Main Methods:

  • Administration of simple iron salts (citrate, chloride, ammonium citrate) and complex compounds (cross-linked dextran and stabilized polynuclear iron hydroxide) to non-uremic and uremic rats.
  • Measurement of urinary phosphate excretion in uremic rats as an indicator of intestinal phosphate uptake.
  • Evaluation of a stabilized polynuclear iron hydroxide compound in subjects with preterminal renal failure.

Main Results:

  • Simple iron salts and complex iron compounds effectively inhibited net intestinal phosphate uptake in experimental models.
  • The stabilized polynuclear iron hydroxide compound reduced urinary phosphate excretion in uremic rats, indicating reduced intestinal phosphate uptake.
  • This iron compound demonstrated effectiveness in subjects with preterminal renal failure with no observed short-term side effects or toxicity.

Conclusions:

  • Trivalent iron-containing compounds, particularly stabilized polynuclear iron hydroxide, represent a promising new class of phosphate binders.
  • These iron-based binders effectively reduce intestinal phosphate absorption, offering a potential alternative to existing therapies.
  • Further evaluation is warranted to confirm the safety and efficacy of these novel compounds in managing phosphate balance in renal patients.

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