Phosphate Binders - Pros and Cons



Calcium carbonate (TumsTM) 

 - Most inexpensive, antacid properties useful for reflux and peptic ulcer disease 

Calcium Acetate (PhosLo) 

 - Relatively inexpensive, less GI calcium absorption compared to Ca carbonate 

Aluminum hydroxide (Amphogel) 

 - Most effective, potent binder, inexpensive 

Sevelamer-HCI (RenageI) 

 - Calcium and metal-free binder; may have ancillary benefits such as lipid lowering, uric acid lowering, anti-inflammatory effect. 



Sevelamer Carbonate (Renvela) 

 - Calcium and metal-free binder; may have ancillary benefits (see above), no metabolic acidosis. 

 - Improved GI tolerance. 

Lanthanum Carbonate (Fosrenol) 

 - No calcium load. Low pill burden. 

Magnesium based (MagneBind) 

 - Minimal calcium load. 

 - Anti-constipating. 

Trivalent iron containing binders (sucroferric oxyhydroxide Velphoro, ferric citrate Auryxia)

 - No calcium load. Low pill burden 

 - May supply additional Fe, decrease ESA 



Dr. Edgar V. Lerma @edgarvlermamd - Nephrology Secrets https://amzn.to/34t5DgJ



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