Comparison of Phosphate

Binders
 Est. PO4
Common Potential Side Effects/
Binder Forms Dose Binding Advantages
Name Disadvantages
Capacity
Calcium Tums, Tablet, Contains 200mg ~39mg/g Effective, Not covered by
Carbonate Oscal, chewable, elemental Ca per inexpensive, insurance,
Calcichew, capsule, 500mg, dose should available OTC, long- hypercalcemia,
Caltrate liquid, gum not exceed 2k- term data progression of vascular
2.5kmg/day calcification (VC),
constipation, GI side
effects, low-turnover
bone disease
Calcium Phoslo, Tablet, gel 2 tablets or 2 gel caps ~45mg/g Less Ca absorption Hypercalcemia,
Acetate Phoslyra cap, liquid per meal, 10ml per than calcium progression of VC, GI
meal. 160mg carbonate, side effects, low-
elemental Ca per effective, turnover bone disease,
capsule, dose should inexpensive, constipation
not exceed 2k- readily available,
2.5kmg/day long-term data
Magnesium Numerous Tablet 235mg/435mg, max - Effective, Hypermagnesemia,
carbonate/ drug dose 3-6 pills/day inexpensive, hypercalcemia, GI side
calcium names decreased Ca load effects, no long -erm
acetate compared to Ca- data
based binders
 Est. PO4
Common Potential Side Effects/
Binder Forms Dose Binding Advantages
Name Disadvantages
Capacity

Aluminum Alternagel, Capsule, 300-600mg 3x/day, - Very effective, Aluminum toxicity, GI

hydroxide Amphojel, tablet, aluminim content inexpensive side effects, altered
Nephrox liquid ranges from 100 to bone mineralization,
>200mg/day, limit use anemia
to no more than 4
weeks

Lanthanum Fosrenol Chewable 500-1,000mg/day (3-6 Varies – High binding Expensive, GI side
carbonate tablet, chewable tablets) 135mg/g, capacity, reduced effects, potential for
powder 3x/day 45mg/500m pill burden, Ca-free lanthum accumulation
g in bones and tissue, no
long-term data

Sevelemer Renagel Tablet 2-4 400mg/meal, 1-2 ~21mg/g Effective, Ca-free, Expensive, GI side
hydrochloride 800mg/meal, max nonmetal binder, effects, metabolic
dose 13g/day not absorbed, acidosis, interferes with
reduced lipid Vitamin K and D
levels, potentially absorption,
decreased VC contraindicated for SBO
risk
 Est. PO4
Common Potential Side Effects/
Binder Forms Dose Binding Advantages
Name Disadvantages
Capacity
Sevelemer Renvela Tablet, 1-2 tablets/meal, 0.8- ~21g/g Effective, Ca-free, Expensive, GI side
Carbonate powder 1.6g/meal, max dose nonmetal binder, effects, interferes with
14g/day not absorbed, Vitamin K and D
reduced lipid absorption,
levels, potentially contraindicated for SBO
decreased VC risk

Sucroferric Velphoro Chewable 500mg (1 tablet) 130mg/tab Effective, Ca-free, Expensive, GI side
oxyhydroxide tablet 3x/day, max dose low pill burden, effects, cannot be taken
3000mg/day potentially with oral levothyroxine,
increases unknown if iron
transferrin, iron, accumulates, long-term
and Hgb levels side effects unknown
Ferric Citrate Auryxia Tablets 2 tablets 3x/day, max - Effective, Ca-free, Expensive, GI side
dose 12 tablets/day lower pill burden, effects, unknown if iron
potentially accumulates, long-term
transferrin, iron, side effects unknown
and Hgb levels,
and decreases
iron and ESA use
References
• Jovanovich, A., & Kendrick, J. (2018, July). Personalized management of bone and
mineral disorders and precision medicine in end-stage kidney disease. In Seminars
in nephrology (Vol. 38, No. 4, pp. 397-409). WB Saunders.
• Gutekunst, L. (2016). An update on phosphate binders: a dietitian's
perspective. Journal of Renal Nutrition, 26(4), 209-218.
• Umeukeje, E. M., Mixon, A. S., & Cavanaugh, K. L. (2018). Phosphate-control
adherence in hemodialysis patients: current perspectives. Patient preference and
adherence, 12, 1175.
• Molony, D. A., & Stephens, B. W. (2011). Derangements in phosphate metabolism in
chronic kidney diseases/endstage renal disease: therapeutic
considerations. Advances in chronic kidney disease, 18(2), 120-131.
• Ketteler, M., Block, G. A., Evenepoel, P., Fukagawa, M., Herzog, C. A., McCann, L., ...
& Leonard, M. B. (2017). Executive summary of the 2017 KDIGO Chronic Kidney
Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed
and why it matters. Kidney international, 92(1), 26-36.