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Phosphate binder usage in kidney failure patients.

Anthony J Bleyer1

  • 1Section on Nephrology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. ableyer@wfubmc.edu

Expert Opinion on Pharmacotherapy
|June 5, 2003
PubMed
Summary

Dialysis patients often need phosphorus binders due to dietary restrictions and incomplete phosphorus removal. Newer binders like sevelamer reduce vascular calcification compared to older calcium-based options.

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Area of Science:

  • Nephrology
  • Pharmacology

Background:

  • Patients with kidney failure struggle to manage phosphorus levels due to dialysis limitations and dietary restrictions.
  • Aluminum and calcium-based phosphorus binders have been historically used but pose risks like toxicity and vascular calcification.
  • The need for safer and more effective phosphorus management in dialysis patients is critical.

Purpose of the Study:

  • To review the evolution and efficacy of phosphorus binders in kidney failure patients.
  • To highlight the risks associated with traditional binders and the benefits of newer alternatives.
  • To discuss ongoing research and future directions in phosphorus binder development.

Main Methods:

  • Literature review of phosphorus binder usage in chronic kidney disease and dialysis.
  • Analysis of clinical data comparing different classes of phosphorus binders.
  • Examination of research on vascular calcification rates associated with binder therapies.

Main Results:

  • Aluminum binders were replaced by calcium binders due to toxicity concerns.
  • Calcium binders, while effective, are linked to increased vascular calcification.
  • Sevelamer, a polymer binder, demonstrates reduced vascular calcification rates compared to calcium-based binders.

Conclusions:

  • Sevelamer offers an improved safety profile regarding vascular calcification in dialysis patients.
  • Lanthanum carbonate and iron-complex preparations are emerging as alternative phosphorus binders.
  • Future research should focus on developing binders with enhanced phosphate binding, improved gastrointestinal tolerance, and additional patient benefits.

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