Contemporary management of phosphorus retention in chronic kidney disease: a review

Abstract

Hyperphosphatemia is the most common metabolic complications of end-stage kidney disease (ESKD). Large observational studies have identified hyperphosphatemia as an independent risk factor for cardiovascular disease and mortality in dialysis patients and subsequent studies found that subtle increases in serum phosphate levels even within the normal range are also associated with increased risk for death in predialysis and non-kidney disease population. On the basis of these results, current national practice guidelines advocate more aggressive treatment of hyperphosphatemia to lower serum phosphate targets than in the past . Treatment of hyperphosphatemia requires to strict management through dietary restriction, oral phosphate binders, and dialysis. Calcium-based phosphate binders have low cost and widespread use but cause vascular calcification and hypercalcemia. Non-calcium-based phosphate binders are effective but expensive. Bixalomer is a new Ca-free, metal-free, potent phosphate binder, non-hydrochloride, and non-absorptive polymer, which improves metabolic acidosis. FGF-23 appears as a promising target for novel therapeutic approaches to improve clinical outcomes of CKD patients. This review focuses on novel therapeutic approaches dealing with hyperphosphatemia in chronic kidney disease.

Comparison of Phosphate Binding Capacities of PA21, A Novel Phosphate Binder, with those of other Phosphate Binders in vitro and in vivo

“…Lanthanum carbonate hydrate, sevelamer hydrochloride, and calcium carbonate are the oral phosphate binders in cur rent use, and ferric citrate hydrate has recently entered clinical use. However, the phosphate binding characteristics of these drugs are known to vary [11][12][13][14]. PA21 (sucroferric oxyhydroxide), which is pro duced by Vifor Pharma (Glattbrugg, Switzerland), is a novel ironbased, noncalciumbased oral Abstract ▼ Purpose: The phosphate binding capacity of PA21, a novel phosphate binder, was compared with those of other phosphate binders in vitro and in vivo.…”

“…Hyperphosphatemia is a major risk factor in patients with CKD and severely affects their prognosis. Treatment for hyperphos phatemia is therefore provided to patients with CKD, including restriction of phosphorus intake with dietary counseling, elimi nation of phosphorus by dialysis, and orally administered phos phate binders [11]. Phosphate binders play a key role in the treatment of hyperphosphatemia in patients with CKD, and phosphate binders that have steady effects on phosphate adsorp tion and can control the serum phosphorus level are considered to be useful.…”

A comparison between the combined effect of calcium carbonate with sucroferric oxyhydroxide and other phosphate binders: an in vitro and in vivo experimental study

“…Hyperphosphatemia is one of the important risk factors which affecting mortality in dialysis patients [3, 17]. The control of serum phosphorus level is performed as treatment of hyperphosphatemia, through dietary phosphate restriction, dialysis, and oral administration of phosphate binders, and especially phosphate binders play a major role in the control of serum phosphorus levels [18, 19]. Various drugs are used as phosphate binders, and each drug has its own advantages, disadvantages, and adverse effects [19–21].…”

Practical Nutrition Management of Children with Chronic Kidney Disease

“…Hyperphosphatemia is an independent risk factor that increases cardiovascular morbidity and mortality such as vascular calcifications in patients with CKD and end stage renal disease (ESRD) on dialysis. 10,11 Poor bone health affects linear growth as well. 12 Management of hyperphosphatemia is therefore key in improving these outcomes.…”