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