What are the effects of phosphate-binding agents in chronic kidney disease (CKD)?

Updated: Oct 26, 2020
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Block et al reported that in patients with CKD who have normal or near-normal serum phosphorus levels, these agents significantly reduce serum and urinary phosphorus and discourage secondary hyperparathyroidism progression. The investigators also reported, however, that phosphate binders encourage vascular calcification. [80]

These results are in contrast to those reported in previous experimental findings in animals with CKD and in human clinical trials, in which the use of phosphate binders did not reduce elevated phosphorus levels or decrease the progression to secondary hyperparathyroidism. Moreover, the effect of calcification is different among patients taking calcium-containing phosphate binders relative to those taking non–calcium-containing phosphate binders.

Furthermore, no randomized, controlled trials have shown improved mortality in dialysis patients who were treated with phosphate binders, activated vitamin D, or cinacalcet to manage moderate to severe hyperparathyroidism.


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