Phosphate binders are

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field an ...

s used to reduce the absorption of dietary

phosphate In chemistry, a phosphate is an anion, salt, functional group or ester derived from a phosphoric acid. It most commonly means orthophosphate, a derivative of orthophosphoric acid . The phosphate or orthophosphate ion is derived from phosph ...

; they are taken along with meals and snacks. They are frequently used in people with

chronic kidney failure Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include pedal edema, leg swelling, feelin ...

(CKF), who are less able to excrete phosphate, resulting in an elevated serum phosphate.

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

magnesium Magnesium is a chemical element with the symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 of the periodic ...

aluminium Aluminium (aluminum in AmE, American and CanE, Canadian English) is a chemical element with the Symbol (chemistry), symbol Al and atomic number 13. Aluminium has a density lower than those of other common metals, at approximately o ...

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...

, or lanthanum salts) that react with phosphate and form an insoluble compound. Phosphate binders such as sevelamer may also be

polymer A polymer (; Greek ''poly-'', "many" + '' -mer'', "part") is a substance or material consisting of very large molecules called macromolecules, composed of many repeating subunits. Due to their broad spectrum of properties, both synthetic and ...

ic structures which bind to phosphate and are then excreted.

Medical use

For people with chronic kidney failure, controlling

serum Serum may refer to: *Serum (blood), plasma from which the clotting proteins have been removed **Antiserum, blood serum with specific antibodies for passive immunity * Serous fluid, any clear bodily fluid * Truth serum, a drug that is likely to mak ...

is important because it is associated with bone pathology and regulated together with serum

by the parathyroid hormone (PTH). They are also used in hypoparathyroidism which presents with hypocalcemia with hyperphosphatemia.

Adverse effects

With regard to phosphate binders, aluminium-containing compounds (such as aluminium hydroxide) are the least preferred because prolonged aluminium intake can cause

encephalopathy Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but ...

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

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.

Types

* Calcium acetate/magnesium carbonate

References

# Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL
Hyperphosphatemia: Practice Essentials, Background, Pathophysiology
Accessed on July 14, 2005. #

External links

High Phosphate Control - Official Fosrenol Homepage

Phosphate Binders: What Are They And How Do They Work?
- American Association of Kidney Patients*

- National Kidney Foundation

- Northwest Kidney Centers - a center that provides services for people with ESRD in the

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area.
High Phosphate - Phosphorus Control
- Information for healthcare professionals on the treatment and management of hyperphosphatemia

Common Phosphate Binders

*

- medlineplus.org

- medlineplus.org
Sevelamer
- Renvela.com {{Drugs for treatment of hyperkalemia and hyperphosphatemia Nephrology procedures