What do phosphate binders do

Additionally, some of the calcium from these binders is absorbed into the bloodstream and may deposit in small blood vessels, causing organ damage. Chewable Fosrenol lanthanum carbonate is another aluminum and calcium free binder. Aluminum-based phosphorus binders have been shown to have toxic side effects that cause bone disease and damage the nervous system, therefore they are rarely prescribed as a long-term phosphorus binder today.

Aluminum based binders may be prescribed for short term use when phosphorus is poorly controlled and other binders are not effective. Magnesium levels should be monitored. This phosphate binder may be appropriate for peritoneal dialysis PD patients, who tend to run lower magnesium levels. Share Print. Related kidney diet education articles on DaVita.

Download Cookbooks. Dining Out Guides. Remember Me. Don't have an account? Join the myDaVita community to connect with others, get kidney diet tools and more. Register for Free. Help Center. Some binders work like magnets, while others work like sponges. They bind to or soak up phosphorus in food during digestion. Then the binders and phosphorus are removed through bowel movements.

If a binder is not taken, phosphorus can accumulate in the blood. Your doctor will determine which type of phosphate binder is best for you. Phosphorus is a very common mineral and can be found in many processed foods and cola drinks. As more phosphates are used in the food supply, this number continues to rise.

Phosphorus from phosphate additives is absorbed almost percent compared to naturally occurring phosphorus of which 40 to 60 percent is absorbed. Binders must be taken as prescribed by your physician. They are usually prescribed to be taken each time you eat meals, snacks or supplements. Timing is everything: Be sure to take your binders when you eat food — the longer you wait, the less they work.

It comes as a chewable tablet and offers the advantage of requiring the patient to take fewer pills than sevelamer and calcium-based binders. Lanthanum is minimally absorbed and is eliminated mainly by the hepatobiliary pathway.

There were initial concerns regarding possible toxicity from accumulation. However, a study looking at ten-year data on lanthanum use showed no evidence of serious toxicity or accumulation. The most commonly reported side effects were nausea and diarrhea.

A disadvantage of lanthanum is its relatively high cost. Sucroferric oxyhydroxide comes as a chewable tablet. It has been shown to be noninferior to sevelamer. Advantages include a significantly lower pill burden. One gram of ferric citrate delivers mg of elemental iron. The main advantage of ferric citrate is its ability to increase iron markers.

The phase 3 trial that demonstrated its efficacy as a binder showed an increase in ferritin compared with the active control. Disadvantages of ferric citrate include high pill burden, high cost and gastrointestinal side effects such as nausea and constipation.

Chitosan binds salivary phosphorus. It can potentially be used, but it is not approved , and its efficacy in lowering serum phosphorus remains unclear. Involving patients in the choice after discussing potential side effects, pill burden and cost is important for shared decision-making and could play a role in improving adherence. Phosphorus binders are a major portion of the pill burden in patients with end-stage renal disease, possibly affecting patient adherence.

The cost of phosphorus binders is estimated at half a billion dollars annually, underlining the significant economic impact of phosphorus control. Calcium-based binders should be the first choice when there is secondary hyperparathyroidism without hypercalcemia.

There is no clear evidence regarding the benefit of correcting hypocalcemia, but KDIGO recommends keeping the serum calcium level within the reference range. KDIGO also recommends restricting calcium-based binders in persistent hypercalcemia, arterial calcification and adynamic bone disease. This recommendation is largely based on expert opinion. Noncalcium-based binders , which in theory might prevent vascular calcification, should be considered for patients with at least one of the following:.