Title:The Rising Risk of Chronic Kidney Disease (CKD) and How it is Dealt
with: A Review of Current and Potential Phosphate Binders (PB)
Volume: 21
Issue: 19
Author(s): Robert Gosik and Krzysztof Danel*
Affiliation:
- Department of Chemistry, Faculty of Food Technology, University of Agriculture, Kraków, Poland
Keywords:
Chronic kidney disease, hyperphosphatemia, phosphate binders, non-calcium PBs, efficacy, alternative.
Abstract: It is estimated that by 2040, Chronic Kidney Disease (CKD) will be the 5th main cause of
global deaths. It has been suggested that hyperphosphatemia is among the main factors leading to the
increased risk of death. This review focuses on potential and currently used Phosphate Binders (PB).
Aluminum hydroxide is presently not recommended due to potential aluminum toxicity. Calciumcontaining
phosphate binders (CCPB) can cause calcium overload, resulting in hypercalcemia and an
increased risk of cardiovascular diseases. Magnesium and calcium complexes were suggested to be as
effective as sevelamer in the reduction of serum phosphate, with the potential to slow down the process
of calcification. However, limited studies have been conducted in this area. Although sevelamer
seemed to have a positive influence on cardiovascular calcification and arterial stiffness, its influence
on mortality was unclear. Sevelamer crystal accumulation in the Gastrointestinal tract (GI) can cause
gastrointestinal bleeding. Lanthanum carbonate seemed to lower all-cause mortality and reduce the
chance of hypercalcemia, even though a deposit in the GI tract was observed. Colestilan, like sevelamer,
reduced LDL cholesterol. Sucroferric oxyhydroxide had a lower pill burden than other PBs and
it seemed to reduce serum FGF-23. Ferric citrate improved parameters that are related to anemia but
can cause iron overload. Bixalomer appeared to have fewer gastrointestinal side effects than sevelamer.
Nano-lanthanum hydroxide and SBR759 may have an interesting future as PBs. In conclusion, the
development of new PBs should also take into consideration their potential to function as protection
modifiers.