Chronic kidney disease (CKD) patients on hemodialysis often struggle with hyperphosphatemia, a condition that significantly increases cardiovascular disease risk and mortality. Phosphate binders, taken orally with dietary phosphate restrictions, are key in managing elevated serum phosphate levels. Traditional binders include calcium-based and aluminum-based options, while newer alternatives are non-calcium-based binders such as sevelamer, lanthanum, and iron-based agents like ferric citrate.
Calcium-based binders, like calcium carbonate and calcium acetate, are widely used due to their cost-effectiveness, despite potential gastrointestinal side effects and the risk of hypercalcemia. Sevelamer, available as hydrochloride and carbonate, avoids calcium-related issues and has shown benefits in reducing serum phosphorus and improving lipid profiles. Ferric citrate, an iron-based binder, offers dual benefits of lowering phosphate levels and improving iron stores, thus aiding in anemia management.
Despite advancements, challenges remain, including medication adherence and potential long-term safety concerns with iron-based binders. Future research is essential to address these challenges and optimize phosphate management in CKD patients.
