If your phosphorus levels are not in a healthy range, you can talk with your doctor or dietitian and take action to change what you are eating. They may also adjust your phosphorus binder prescription, if you need another brand or should be taking a different amount. Phosphorus binders work in one of two ways. Instead it is carried through the digestive tract and eliminated in the stool.
Other phosphorus binders, such as Fosrenol, Phoslo and Tums, work like a magnet. The phosphorus in the food connects to the phosphorus binder and it is carried through the digestive tract to be eliminated. Some people may be prescribed a combination of phosphorus binders to help keep their phosphorus level in a healthy range. There are four common types of phosphorus binders: calcium-based phosphorus binders; aluminum-free, calcium-free phosphorus binders; aluminum-based phosphorus binders; and magnesium-based phosphorus binders.
Phosphorus binders combined with a low-phosphate diet can help keep you active and healthy. Talk to your doctor or dietitian to find out more about phosphorus binders and which combination may work best for you. Access free kidney-friendly cookbooks from DaVita dietitians. See kidney-friendly food and drink choices to consider when eating out at your favorite restaurants.
Choose from 12 cuisine types. Download Now. How do phosphorus binders work? People in the studies had a range of kidney function, and many were on dialysis. Overall we could not be certain of a number of important outcomes because many of the clinical studies we included had important flaws in their design.
Sevelamer treatment may have decreased death for those patients given this medication when taken instead of calcium. The phosphate binders probably caused constipation, but we could not be very certain about the risks of other side-effects.
We were not very certain whether phosphate binders reduced heart complications, stroke, bone pain, or calcification of blood vessels. Overall, we are not very sure whether specific phosphate binders are beneficial to patients with CKD. There is a possibility that sevelamer may prevent death compared to calcium-based binders, but we don't know whether this may be caused by an increased risk of calcium-based binders, a lower risk with sevelamer treatment, or the possibility that both may be true.
Patients need to know that it is not certain whether phosphate binders help to prevent complications of kidney disease, but sevelamer may be preferred to calcium binders. We did not find differences in the effects of treatment for patients on dialysis and those not on dialysis, although most studies evaluating treatment with calcium-based binders were among dialysis patients and those comparing binders with placebo were among people not treated with dialysis.
In studies of adults with CKD G5D treated with dialysis, sevelamer may lower death all causes compared to calcium-based binders and incur less treatment-related hypercalcaemia, while we found no clinically important benefits of any phosphate binder on cardiovascular death, myocardial infarction, stroke, fracture or coronary artery calcification.
The effects of binders on patient-important outcomes compared to placebo are uncertain. In patients with CKD G2 to G5, the effects of sevelamer, lanthanum, and iron-based phosphate binders on cardiovascular, vascular calcification, and bone outcomes compared to placebo or usual care, are also uncertain and they may incur constipation, while iron-based binders may lead to diarrhoea.
Phosphate binders are used to reduce positive phosphate balance and to lower serum phosphate levels for people with chronic kidney disease CKD with the aim to prevent progression of chronic kidney disease-mineral and bone disorder CKD-MBD. This is an update of a review first published in The aim of this review was to assess the benefits and harms of phosphate binders for people with CKD with particular reference to relevant biochemical end-points, musculoskeletal and cardiovascular morbidity, hospitalisation, and death.
We searched the Cochrane Kidney and Transplant Register of Studies up to 12 July through contact with the Information Specialist using search terms relevant to this review. Outcomes included all-cause and cardiovascular death, myocardial infarction, stroke, adverse events, vascular calcification and bone fracture, and surrogates for such outcomes including serum phosphate, parathyroid hormone PTH , and FGF Two authors independently selected studies for inclusion and extracted study data.
We estimated treatment effects using random-effects meta-analysis. We included studies involving 13, adults. Calcium-containing binders CCBs are well tolerated, reasonably effective and have a low cost.
In contrast, high doses of CCBs have been associated with increased cardiovascular calcification [ 7 ]. Lower doses might not be that harmful, but they are less effective. Their use in the presence of signs of vascular calcification should be considered very carefully and probably avoided. For this reason, non-calcium- and non-aluminum-based phosphate binders emerged [ 8 ]. Sevelamer hydrochloride initially and later carbonate have been proven to be an effective phosphate binders, showing also additional favourable effects, such as lowering low-density lipoprotein cholesterol levels, without aggravating vascular calcification [ 9 ].
Unfortunately, sevelamer suffers from a high pill burden in order to achieve the desirable serum phosphorus levels, together with some gastrointestinal discomfort.
Additionally, cost is another factor that might have limited its prescription in some countries. Lanthanum carbonate is a second non-calcium-containing phosphate binder.
It is a potent binder, usually needing fewer pills to achieve the desired effect. Similar to sevelamer, the cost of lanthanum is also a problem. Furthermore, lanthanum carbonate pills are chewable, a fact that, due to its taste, constitutes a major drawback for some patients since, like all phosphate binders, they should be consumed during meals [ 10 ].
More recently in Europe, the iron-based phosphate binder sucroferric oxyhydroxide SO has been made available to treat hyperphosphataemia in dialysis patients [ 11 ]. It is safe and effective, with minimal gastrointestinal side effects.
Navarro-Gonzales et al. Serum phosphate levels decreased from 5. In Figure 1 we graphically represent the major characteristics of phosphate binders used in dialysis. In summary, phosphate binders should be tailored to the patient.
The impact of phosphate load on survival remains a hot topic in contemporary medicine. Improving knowledge about phosphate balance and its potential toxicity is challenging, but is needed to improve the care of the general population and renal patients. Further insights are urgently needed to bridge the gaps in our knowledge of pathophysiology and epidemiology. While we wait for dedicated randomized controlled trials on the topic, current evidence is mainly observational and insufficient to recommend different interventions from those purposed in the current guidelines.
Phosphate balance in ESRD: diet dialysis and binders against the low evident masked pool. J Nephrol ; 28 : — Google Scholar. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol ; 16 : — Phosphorus binders and survival on hemodialysis. J Am Soc Nephrol ; 20 : — Use of phosphate-binding agents is associated with a lower risk of mortality.
Kidney Int ; 84 : — Nephrol Dial Transplant ; 29 : — Use of calcium carbonate as a phosphate binder in dialysis patients. Miner Electrolyte Metab ; 12 : — Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.
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