Phosphate binder

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Phosphate binders are medications used to reduce the absorption of dietary phosphate; they are taken along with meals and snacks. They are frequently used in people with chronic kidney failure (CKF), who are less able to excrete phosphate, resulting in an elevated serum phosphate.

Mechanism of action[edit]

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 magnesium, 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.

Medical use[edit]

For people with chronic kidney failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH).[1]

They are also used in hypoparathyroidism which presents with hypocalcemia with hyperphosphatemia.

Adverse effects[edit]

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.

Choice of agent[edit]

There have been limited trials comparing phosphate binders to placebo in the treatment of hyperphosphatemia in people with chronic kidney disease. When compared with people receiving calcium-based binders, people taking sevelamer have a reduced all-cause mortality.[1]


Summary of Common Oral Phosphate Binders[2]
Phosphate Binder Brands Advantages Disadvantages
Aluminum salts Alucaps Calcium free Risk of aluminum toxicity
Basaljel High binder efficiency regardless of pH Requires frequent monitoring-extra cost
Moderate tablet burden
Calcium carbonate Calcichew Aluminum free Calcium containing-potential risk of hypercalcemia and ectopic calcification
Titralac Moderate binding efficacy Parathyroid hormone oversuppression
Relatively low cost Gastrointestinal side effects
Moderate tablet burden Efficacy pH dependent
Calcium acetate Lenal Ace Aluminum free Calcium containing-potential risk of hypercalcemia and ectopic calcification
PhosLo Higher efficacy than calcichew/sevelamer Parathyroid hormone oversuppression
Moderately cheap Gastrointestinal side effects
Lower calcium load than calcium carbonate Large tablets & capsules, nonchewable formulation
Sevelamer hydrochloride/Sevelamer carbonate Renagel Aluminium and calcium free Relatively costly
Renvela No gastrointestinal absorption High pill burden
Moderate efficacy Large tablets, nonchewable formulation
Reduces total and low-density lipoprotein cholesterol Gastrointestinal side effects
Binds fat-soluble vitamins
Lanthanum carbonate Fosrenol Aluminum and calcium free Relatively costly
Minimal gastrointestinal absorption Gastrointestinal side effects
High efficacy across full pH range
Chewable formulation
Low tablet burden
Ferric Citrate Auryxia Iron based Very costly
Tablets can be toxic to young children
Stool discoloration - may turn them black, obscuring intestinal bleeding


  1. ^ Patel, L; Bernard, LM; Elder, GJ (14 December 2015). "Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials". Clinical Journal of the American Society of Nephrology. 11 (2): 232–244. doi:10.2215/CJN.06800615. PMC 4741042. PMID 26668024.
  2. ^ Burtis, C.A.; Ashwood, E.R. and Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th Edition. Elsevier. pp1552
  1. ^ Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia,, URL:, Accessed on July 14, 2005.
  2. ^ Spiegel, David M.; Farmer, Beverly; Smits, Gerard; Chonchol, Michel (2007). "Magnesium Carbonate is an Effective Phosphate Binder for Chronic Hemodialysis Patients: A Pilot Study". Journal of Renal Nutrition. 17 (6): 416–22. doi:10.1053/j.jrn.2007.08.005. PMID 17971314.

External links[edit]

Common Phosphate Binders[edit]