The therapeutic potential of novel phosphate binders

Hyperphosphatemia and an increased serum calcium-phosphate (CaxP) product are associated with cardiovascular mortality in adult dialysis patients. Target levels for the treatment of elevations in serum phosphorus (P) and the CaxP product have recently been redefined, but are difficult to achieve in clinical practice. This problem may be especially prevalent in children and adolescents who have a higher recommended P intake than adults and also a higher calcium (Ca) load with the intake of comparatively higher doses of Ca-containing phosphate binders. Current treatment practice with Ca-containing P binders carries the risk of hypercalcemic episodes and ectopic calcifications, including vascular calcifications, which are associated with an increased risk of cardiovascular disease. Novel P binders in the development phase include several iron-containing preparations. Clinical experience with lanthanum carbonate is limited to date and further studies are needed to establish its safety. The only available Ca-free P binder with widespread use and large-scale clinical safety data in adults is sevelamer. Preliminary data suggest that this drug can also be safely given to children.