New developments in the management of hyperphosphatemia in chronic kidney disease

Hyperphosphatemia is a characteristic complication of significant chronic kidney disease. Elevated serum phosphorous is associated with reduced survival. Hyperphosphatemia has long been recognized as predisposing to uremic bone disease and disorders of parathyroid function. Furthermore, elevated serum phosphate has been implicated particularly in the development of cardiovascular structural and functional abnormalities. Given the limitations of restricting phosphate in the diet and the inadequate removal by conventional dialysis regimes, nephrologists rely on the use of additional medications to control serum levels (currently oral phosphate binders). This review focuses on new agents and therapeutic approaches dealing with hyperphosphatemia in chronic kidney disease, that are not currently licensed and available in routine clinical practise. This article attempts to review therapies under development and considers additional effects that the next generation of agents may bring over and above those already within the therapeutic armamentarium.