Phosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in patients with chronic renal failure (CRF) as they cannot get rid of the phosphates that get into their blood (i.e. the serum phosphate in chronic renal failure is typically elevated).
For patients with chronic renal failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH).
Mechanism of action
These agents work by binding to phosphate in the GI tract, thereby making it unavailable to the body for absorption. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Phosphate binders may be simple molecular entities (such as aluminium, calcium, or lanthanum salts) that react with phosphate and form an insoluble compound. Phosphate binders, such as sevelamer, may also be polymeric structures which bind to phosphate and are then excreted.
With regard to phosphate binders, aluminium-containing compounds (such as aluminium hydroxide) are the least preferred because prolonged aluminium intake can cause encephalopathy and osteomalacia. If calcium is already being used as a supplement, additional calcium used as a phosphate binder may cause hypercalcemia and tissue-damaging calcinosis. One may avoid these adverse effects by using phosphate binders that do not contain calcium or aluminium as active ingredients, such as lanthanum carbonate or sevelamer.
Common phosphate binders
- Aluminium hydroxide (Alucaps, Basaljel)
- Calcium carbonate (Calcichew, Titralac)
- Calcium acetate (Lenal Ace, PhosLo)
- Lanthanum carbonate (Fosrenol)
- Sevelamer (Renagel, Renvela)
- Calcium acetate/magnesium carbonate (Lenal Ace, Renepho)
- ^ Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL: http://www.emedicine.com/med/topic1097.htm, Accessed on July 14, 2005.
- High Phosphate Control - Official Fosrenol Homepage*
- Phosphate Binders: What Are They And How Do They Work? - American Association of Kidney Patients*
- Phosphate Binders - National Kidney Foundation
- Phosphate Binders - Northwest Kidney Centers - a center that provides services for people with ESRD in the Seattle area.
- High Phosphate - Phosphorus Control - Information for healthcare professionals on the treatment and management of hyperphosphatemia
Common Phosphate Binders