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Table 1 Overview of currently available phosphate binders[27, 28, 30, 31, 3537]

From: Hyperphosphatemia in patients with ESRD: assessing the current evidence linking outcomes with treatment adherence

Phosphate binder Mechanism of action Typical daily pillburden* Advantages Disadvantages
Aluminum salts Aluminum binds to phosphates and forms insoluble precipitate in GI tract; aluminum hydroxide also forms compounds with phosphate ions in the blood No safe dose identified Effective, inexpensive Associated with cognitive disturbances, osteomalacia and anemia. Patient requires careful monitoring
Calcium acetate (e.g., Phosex®) Dissociation in GI tract; calcium binds to phosphates and forms insoluble precipitate 4–6 pills (1000 mg each,equivalent to 250 mgcalcium) per day Effective and inexpensive Potential for increased hypercalcemia; could lead to vascular calcification; high pill burden
Calcium carbonate (e.g., Calcichew) Dissociation in GI tract; calcium binds to phosphates and forms insoluble precipitate Pill number as prescribedper day (1250 mg each,equivalent to 500 mg calcium) Effective and inexpensive Potential for increased hypercalcemia; could lead to vascular calcification; high pill burden
Calcium acetate/magnesium carbonate Dissociation of the active compounds calcium acetate and magnesium carbonate in the GI tract; each binds to phosphate and forms insoluble precipitate Total: 3–10 pills per day(each pill contains435 mg calcium acetate/235 mg magnesiumcarbonate) Lower calcium uptake versus calcium-based binders; effective; moderate costs Monitoring of magnesium level required; in some circumstances, moderate increase in serum magnesium level
Sevelamer HCl Anion exchange resin that exchanges chloride ions for phosphate ions 3 pills (800 mg each) three times daily(Total: 9 pills/day) Effective; lipid-lowering effect; potential cardioprotective effect Expensive; high pill burden; associated with GI side effects such as abdominal bloating, diarrhea and constipation. Potential development of metabolic acidosis
Sevelamer carbonate Anion exchange resin that exchanges chloride ions for phosphate ions 3 pills (800 mg each) three times daily(Total: 9 pills/day) Effective; lipid-lowering effect; potential cardioprotective effect; available as a powder, which may reduce pill burden Expensive; high pill burden; associated with GI side effects
Lanthanum carbonate Dissociation in the upper GI tract; lanthanum then binds to phosphates and forms insoluble, non-absorbable lanthanum phosphate complexes 1 pill (500 mg, 750 mg or 1000 mg) three times daily (Total: 3 pills/day) Effective, low pill burden Expensive; associated with GI side effects such as nausea, vomiting
  1. GI = gastrointestinal, HCl = hydrochloride.
  2. *Timing and dose of phosphate binder to be adjusted in line with timing of meals/snacks and the phosphorus content thereof.