Summarize the pros and cons of common phosphate binders overtime.

26 Comments

  • Rania Mahmoud


    Summarize the pros and cons of common phosphate binders overtime.
    Aluminum salts:
    -Introduced in the 1970s, were the first phosphate binders
    -Reduce phosphate availability by forming coordination compounds with phosphate ions, creating insoluble
    aluminum phosphate precipitates in the GI tract
    -Pros : effective
    -Cons: neurotoxicity,16 cognitive disturbances, osteomalacia, and anemia
    Calcium-based phosphate binders:
    -Pros: effective,20,21 inexpensive,22 and widely used
    -Cons : vascular calcification and increased arterial stiffness
    A combination of magnesium hydroxide and aluminum hydroxide
    -Pros : effective for phosphate control in the 1980s and did not cause uncontrolled hypermagnesemia
    Calcium acetate/magnesium carbonate was also found to effectively lower phosphorus levels and was not associated with anincreased risk of hypercalcemia calcium acetate/magnesium carbonate at doses that reduced vascular calcification did not adversely affect bone remodeling or alter bone magnesium levels.
    -Cons: not widely studied
    Sevelamer hydrochloride
    -Pros: decreased phosphorus concentrations without increasing calcium load. Sevelamer may lead to lower all-cause death.
    and induce less hypercalcemia than calciumbased binders.
    -Cons: no clinically significant difference for outcomes of CV death, myocardial infarction, stroke, fracture, or coronary artery calcification and worsen metabolic acidosis
    Lanthanum carbonate
    -Pros : approved in 2004, also reduces phosphorus levels without increasing calcium
    load, potentially decreasing the risk of treatmentrelated hypercalcemia
    -Cons: GI obstruction, ileus, GI perforation, and fecal impaction
    Iron-based binders are sucroferric hydroxide and ferric citrate:
    -Pros: Sucroferric hydroxide was approved in 2013. It effectively reduces phosphorus
    levels in patients undergoing dialysis and has a lower pill burden than sevelamer carbonate. Ferric citrate
    was approved in 2014. Ferric citrate use and revealed it to be effective in lowering phosphorus and phosphoruscalcium product.
    Cons:The medication caused significantly higher GI side effects.

  • Mohamed Abdalbary


    Here is a suggested answer:

    Aluminum salts, were the first phosphate binders, reduce phosphate availability by forming coordination compounds with phosphate ions, creating insoluble aluminum phosphate precipitates in the GI tract.

    Pros: effective, cheap

    Cons: Al toxicity, neurotoxicity,16 cognitive disturbances, osteomalacia, and anemia

    Calcium-based phosphate binders

    Pros: effective, inexpensive, and widely used.

    Cons: potential drivers of vascular calcification and, thus, contributors to increased CV mortality.23 Increased calcium load from the use of calcium-based binders has been associated with vascular calcification and increased arterial stiffness.

    A combination of magnesium hydroxide and aluminum hydroxide or Calcium acetate/magnesium carbonate

    Pros: did not cause uncontrolled hypermagnesemia. effectively lower phosphorus levels. reduced serum phosphorus levels and was not associated with an increased risk of hypercalcemia, calcium acetate/magnesium carbonate at doses that reduced vascular calcification did not adversely affect bone remodeling or alter bone magnesium levels.

    Cons: availability, not widely studied

    Sevelamer hydrochloride

    Pros: decreased phosphorus concentrations without increasing calcium load. induce less hypercalcemia than calcium based binders.

    Cons: no clinically significant difference for outcomes of CV death, myocardial infarction, stroke, fracture, or coronary artery calcification.

    Worsen metabolic acidosis, sevelamer carbonate was developed as an alternative. However patients treated with sevelamer hydrochloride had a greater mean decrease in serum phosphorus than those treated with sevelamer carbonate.

    Lanthanum carbonate

    Pros: reduces phosphorus levels without increasing calcium load,

    Cons: prescribing information for lanthanum includes a precaution that serious cases of GI obstruction, ileus, GI perforation, and fecal impaction have been reported. Some cases required surgery or hospitalization. Patients are advised to chew the tablet completely to reduce the risk of these serious adverse GI events. In addition, accumulation of lanthanum carbonate in the liver has been observed in animal models, as The liver is the main route for lanthanum excretion, however no conclusive evidence of hepatotoxicity related to lanthanum  Hence, preexisting liver disease is not a contraindication to prescribing lanthanum.

    Sucroferric hydroxide and ferric citrate

    Pros: non-calcium, iron-based binders reduce phosphorus levels in patients undergoing dialysis and have a lower pill burden than sevelamer carbonate.

    Cons: the medication caused significantly higher GI side effects.

  • Rola Kotob


    Aluminum salts, 1970s
    pros effective
    cons neurotoxicity, cognitive disturbances, osteomalacia, and anemia.

    Calcium-based phosphate binders 1980s
    pros effective,inexpensive,and widely used.
    cons vascular calcification and, increased CV mortality. increased arterial stiffness

    magnesium containing binders
    pros effective no hypercalcemia, did not adversely affect bone remodeling or alter bone magnesium levels.
    cons hypermagnesemia, diarrhia

    Sevelamer hydrochloride/carbonate was approved by the US FDA in 2000.
    pros effective no hypercalcemia
    cons expensive, GIT upset ileus, bowel obstruction, bowel perforation

    Lanthanum carbonate, approved in 2004,
    pros effective no hypercalcemia
    cons GIT upset ileus, bowel obstruction,fecal impaction, bowel perforation, hepatoxicity

    iron-based binders started in 2013
    pros effective , no hypercalcemia
    cons GI side effects nausea vomitting, feacal discoloration abdominal pain cough

  • Asmaa Salih KHUDHUR


    Alaminuim-based binders
    Pros: effective and cheap
    Cons:cognitive disorder , osteomalacia , anemia.
    Magnesium-based binders
    Pros: effective and cheap
    Cons:hypermagnesemia ,diarrhea.
    Lanthanuim- based binders
    Pros: effective no hypercalcimia 
    Cons: illeus , GI obstruction, GI perforation, feacal impaction.
    Calcium-based binders
    Pros:effective and cheap
    Cons:vascular calcification,arterial stiffness.
    Sevelamir hydrochloride 
    Pros:effective no hypercalcimia 
    Cons:nausea,vomiting, illeus, feacal impaction , intestinal obstruction, intestinal perforation.
    Iron-based binders
    Pros:effective no hypercalcimia 
    Cons:nausea ,vomiting,cough.diarrhea,constipation,abdominal pain,discolored feases.

  • Mohamed Abdulahi Hassan


    The pros and cons of standard phosphate binders over time.

    1. Calcium-containing and aluminum-containing were available for many years and cheaply. Calcium-containing binders are an enticing first choice, but they accelerate hypercalcemia and vascular calcification.

    aluminum-containing binders have a good capacity for phosphate binding, but there was a warning about concern aluminum intoxication.

    1. New non-calcium-based binders are the more expensive
  • Marwa Alm


    phosphate binders (phosphorus chelators):

    1. AL based phosphate binder: effective, cheap, but deposited (aluminum phosphate precipitates) in bone causing osteomalecia, causes dementia and anemia
    2. Ca based phosphate binder: inexpensive, source of calcium supplement in associated hypocalcemia, but increased risk of hypercalcemia contributes to  vascular calcification 
    3. Non AL non Ca (sevelamer): avoid side effects of calcium and aluminum but causes GIT symptoms nausea, vomiting, ilius, fecal impact ion, bowel obstruction and perforation 
    4. Lanthanum: avoid side effects of calcium and aluminum but causes GIT symptoms nausea, vomiting, ilius, serious cases of bowel obstruction and perforation, accumulates in the liver
    5. Iron based: effective, lower pill burden than sevelamer, source of iron, improve iron stores in associated iron deficiency, but causes significantly higher GIT side effects which may lead to ttt discontinuation.
    6. Mg based: source of Mg, but can cause diarrhea and hypermagnesemia

    Drugs targeting phosphorus absorption: 

    1. EOS789: reduce transcellular phosphorus absorption (inhibit NaPi2b cotransporter), but larger studies are lacking to support widespread use.
    2. tenapanor: inhibit paracellular phosphorus absorption (inhibit NHE3), low pill burden (1tab bid), generally tolerable, but causes diarrhea.
  • Ahmed Altalawy


    Aluminum based binders
    Pros:
    effective, cheap .
    Cons :
    cognitive dysfunction, aluminum induced osteomalacia and anemia .
    Calcium based
    Pros:
    Cheap, correct hypocalcemia .
    Cons :
    Vascular calcification, arterial stiffness .
    Magnesium based binders
    Pros
    Effective and cheap .
    Cons:
    Hypermagnesemia, Diarrhea .
    Sevelamer
    Pros
    effective, no hypercalcemia .
    Cons
    GIT side effects, cost .
    lanthanum
    Pros
    effective, no hypercalcemia .
    Cons
    expensive, GIT side effects, accumulation in liver .
    Iron based phosphate binders
    Pros
    effective, no hypercalcemia.
    Cons
    GIT disturbance .

  • Mohammed Farag


    Aluminium based binders
    Cheap , effective
    Osteomalacia, anemia, cognitive impairment
    Mg based binders
    Cheap, effective
    Diarrhea, hypermagnesemia
    Ca based binders
    Cheap
    Hypercalcaemia, calciphylaxis
    Sevelamir
    Effective, avoid hypercalcaemia
    Expensive, GIT complications, acidosis
    Lanthanum
    Effective, avoid hypercalcaemia
    Expensive, GIT complications, bone deposits
    Iron based
    Reduce pill burden, epo dose , effective
    Expensive, teeth staining, constipation

  • Mark Nagy Zaki Amin Mark


    Aluminum based binders:
    pros….form insoluble Al po4 compounds and decrease its absorption
    cons…..neurotoxicity- osteomalacia- anemia- cognitive dse
    calcium base binders:
    pros….decrease po4 and increase calcium stores
    cons….arterial stiffness and vascular calcification
    lanthanum and sevelamer based binders:
    pros….no increase in calcification
    cons….GIT dse as nausea, vomiting , diarrhea , fecal impaction and bowel obstruction and perforation
    Iron based binders:
    pros….decrease po4 and treat anemia as well
    cons….stool discoloration , constipation , GIT dse

  • HASSAN ALYAMMAHI


    Aluminum based binders
    Pros:
    effective, cheap .
    Cons :
    cognitive dysfunction, aluminium induced osteomalacia and anemia

    Calcium based
    Pros:
    Cheap, correct hypocalcemia
    Cons :
    no effect on FGF23 level, soft tissue calcification, arterial stiffness

    Magnesium based binders
    Pros
    Effective and cheap
    Cons:
    Hypermagnesemia, effect on PTH secretion and bone mineralization ,Diarrhea

    Sevelamer
    Pros
    effective, no hypercalcemia,
    Cons
    GIT side effects, costly

    lanthanum
    Pros :
    effective, no hypercalcemia,
    Cons
    expensive, GIT side effects, accumulation in liver

    Iron based phosphate binders
    Pros:
    effective, no hypercalcemia, improve anemia
    Cons:
    GIT disturbance

  • ahmed bhnassi


    A) Aluminum BASED BINDER:
    Pros:
    MOST effective, cheap .
    Cons :
    1- neurotoxicity, 2- cognitive dysfunction, 3- aluminum induced osteomalacia and anemia

    B) Calcium based:
    Pros:
    1- Cheap, 2- effective, 3- correct hypocalcemia 4- reduce hypocalcemia induced hyperparathyroidism,
    Cons :
    1- Minimal or no effect on FGF23 level 2- soft tissue calcification 3- arterial stiffness and 4- increase cardio-vascularevents on advanced cKD patients.

    C) Magnesium based binders
    Pros effective,
    1- Effective and cheap 2- less hypocalcemia
    Cons:
    1- Hypermagnesemia, 2- effect on PTH secretion and bone mineralization , 3-Diarrhea

    Non calcium containing phosphate binders:

    D) Sevelamer:
    Pros
    1- effective, 2- no hypercalcemia,
    Cons
    1- Nausea, vomiting, 2- bowel obstruction, -3- sevelamer hydrochloride cause metabolic acidosis.

    E) lanthanum:
    Pros :
    1- effective, 2- no hypercalcemia,
    Cons
    1- expensive 2- ileus, 3- fecal impaction, 4- bowel obstruction, 5- accumulated in the liver

    F) Iron based phosphate binders:
    Pros:
    1- effective, 2- no hypercalcemia, 3- improve anemia
    Cons:
    1- GIT side effects nausea, vomiting, 2- stool discoloration 3- constipation, 4-abdominal pain

  • Mahmoud Elsheikh


    AL -based binders :
    cheap
    effective.
    But..
    anemia
    neurotoxicity
    adymamic bone disease
    Calcium-based binders:
    Cheap
    Effective
    But..
    vascular/tissues calcification
    Mg-based binders:
    cheap
    ca free .
    but

    diarrhea
    Sevelamer

    effective
    Ca free
    but
    GIT upset
    bowel perforation
    costy
    Lanthanum

    Ca free
    effective .
    but ..
    GIT obstruction
    accumulated in liver cells
    expensive
    iron based binder

    effective
    but
    GIT complication

  • Alaa Abdel Nasser


    Aluminium salts:
    Effective but cause neurotoxicity,cognitive impairment,osteomalacia and anaemia.

    Calcium containing phosphate binders:
    effective, cheap but increase calcium load, vascular calcification and arterial stiffness.

    Magnesium based binders:
    effective but may be associated with diarrhoea and hypermagnesemia.

    Sevelamer hydrocholaride:
    effective without increase calcium load but associated with nausea,vomiting,ileus,fecal impaction,bowel obstruction or perforation,worsen metabolic acidosis.

    Lanthanum carbonate:
    effective without increase calcium load but associated with ileum,fecal impaction,bowel obstruction or perforation and accumulation of lanthanum in the liver.

    Iron based binders(sucroferric hydroxide and ferric citrate):
    reduce phosphorus but cause GI side effects.

  • Rabab ALaa Eldin keshk Rabab


    The first one was Aluminum Pros effective and cheap .
    cons :causes neurotoxicity, cognitive dysfunction, osteomalacia and anemia
    Then calcium based bindersPros:cheap, effective, Cons induce metastatic calcification, arterial stiffness and promote cardio-vascular mortality,
    Then Magnesium based binders
    Pros effective, not causes hypercalcimia
    Cons hypermagnesemia, Mg affect bone turnover and mineralization, diarrhea
    sevelamir non calcium containing phosphate binders Pros effective, not cause hypercalcimia, lower overall mortality Cons causes nausea, vomiting, ileus, fecal impaction, bowel obstruction, bowel perforation, sevelamir hydrochloride cause worsening metabolic acidosis.
    lanthanum Pros effective and not cause hypercalcimia Cons ileus, fecal impaction, bowel obstruction, perforation, accumulated in the liver and no evidence of causing liver injury
    iron based binders Pros effective, not cause hypercalcimia, less pill burden and protect against anemia and decrease consumption of ESA
    Cons more GIT side effects nausea, vomiting, discoloration of stool, diarrhea, constipation, abdominal pain

  • Israa Hammoodi


    *Aluminum salt bind to phosphorous ion and form insoluble aluminum phosphate complex in GIT.
    Pros :effective cons :causes neurotoxicity, cognitive dysfunction, osteomalacia and anemia
    *calcium based binders
    Pros:cheap, effective and wide spread
    Cons :cause vascular calcification, arterial stiffness and high cardio-vascular mortality
    *Magnesium based binders
    Pros :effective, not causes hypercalcimia
    Cons :hypermagnesemia, Mg affect bone turnover and mineralization, diarrhea
    *sevelamir non calcium containing phosphate binders
    Pros :effective, not cause hypercalcimia, lower overall mortality
    Cons : causes nausea, vomiting, ileus, fecal impaction, bowel obstruction, bowel perforation, sevelamir hydrochloride cause worsening metabolic acidosis.
    *lanthanum
    Pros :effective and not cause hypercalcimia
    Cons :ileus, fecal impaction, bowel obstruction, perforation, accumulated in the liver
    *iron based binders
    Pros :effective, not cause hypercalcimia, less pill burden
    Cons : more GIT side effects nausea, vomiting, discoloration of stool, diarrhea, constipation, abdominal pain, cough.

  • KAMAL ELGORASHI


    Phosphate binders pros and cons
    Calcium carbonate;
    Pros;

    • Cheap.
    • Antacid properties.

    Cons;

    • High calcium load.

    Calcium acetate;
    Pros;

    • Relative inexpensive.
    • Less GI side effects.

    Cons;

    • Calcium load.
    • Vascular calcification.

    Aluminum hydroxide;
    Pros;

    • Most effective.
    • Potent binder.
    • Inexpensive.

    Cons;

    • Aluminum toxicity.
    • Not used as maintenance therapy.

    Sevelamer-HCL;
    Pros;

    • Calcium and metal-free binder.
    • lipid-lowering properties.
    • Uric acid lowering properties.
    • Anti-inflammatory effects.

    Cons;

    • Expensive.
    • Metabolic acidosis.
    • GI symptoms.
    • High bill burden.

    Sevelamer carbonate;
    Pros;

    • Calcium and metal free binder.
    • lipid and uric acid lowering properties.
    • No metabolic acidosis.
    • Improved GI tolerance.

    Cons;

    • Expensive.
    • Limited.
    • GI symptoms.
    • High pill burden.

    Lanthanum carbonate;
    Pros;

    • No calcium load.
    • Low pill burden.

    Cons;

    • Expensive.
    • CI in liver disease.
    • Chalky taste.

    Magnesium based;
    Pros;

    • Low calcium load.
    • Anti-constipation.

    Cons;

    • Hypermagnesemia.
    • Diarrhea.

    Trivalent iron containing binder;
    Pros

    • No calcium load.
    • low pill burden.
    • May supply iron. decrease ESA.

    Cons;

    • Expensive.
    • Diarrhea.
    • Dark stool.
  • Ashraf Ahmed Mahmoud


    AL -based binders :
    pros –

    cheap
    effective.

    cons :
    anemia –neurotoxicity—MBD.

    Calcium-based binders:

    pros :

    cheap—— effective

    cons:
    vascular calcification —

    Mg-based binders:

    pros
    cheap—-ca free .

    cons
    diarrhea

    Sevelamer

    pros
    effective —Ca free
    Cons
    GIT upset—-bowel perforation .—-expensive

    Lanthanum
    pros
    Ca free —effective .

    cons
    GIT obstruction —–accumulated in liver cells .—-expensive

    iron based binder

    pros
    effective ———-
    cons
    GIT complication

  • Mahmud ISLAM


    Aluminium hydroxide is still an effective phosphorous binder, but we use as rescue therapy for not more than a couple of weeks when we are unable to use calcium-containing binders not to increase the risk of calcification.
    Still, the Ca-based binders are the main stay of therapy and the first line. Sevalemer or Lantanum are given to patients on dialysis who failed to maintain normal phosphorous levels despite effective dialysis with Ca-based treatment given for a minimum of 3 months. Despite insurance limitations, this is good for relief of the hypocalcemia dominant in end-stage kidney disease.

    aluminium hydroxide is cheap but toxic, leading to cognitive problems and anaemia
    Ca-based binders are cheap and help restore calcium balance but will lead to calcium overload in the long run
    sevelamer is better but may lead to negative calcium balance, less potent (somehow); the burden of the high number of tablets may cause trouble

    Lantanum, available in our country as a powder (500/750/1000) is very effective but gastrointestinal intolerance is a handicap. Accumulation is still something that need to be monitored afterwards. No big problem has been reported till now since Lantanum entered the markets

    NOTE: Price is not an issue (ALL HD patients are covered with government insurance)

  • Rihab Elidrisi


    Aluminum phosphate binder has been used since 1970, it is a good phosphate binder but found to have a lot of side effects which affect its use.It is will not affect the Ca balance.

    Ca phosphate binder it is expensive and affects the total Ca balance which in turn will increase the vascular stiffness.

    Sevelamer and lanthanum both of them are Phosphate binders, expensive and have a lot of GIT side effects

    .

  • Muhammad Soobadar


    Summarize the pros and cons of common phosphate binders overtime.

    calcium-based phosphate binders :
    1- pros : inexpensive.
    2- cons : arterial stifness and vascular calcification.

    Aluminum based phoshate binders
    1- pros : inexpensive, no effect on calcium balance.
    2- Cons : Aluminum toxicity with anaemia, dementia, CKD MBD

    Sevelamer :
    1- pros : no effect on calcium balance.
    2- cons : expensive, unpalatable, GIT side effects, SBO GI perforation ileus fecal impaction

    Lanthunum :
    1- pro : no effect on calcium balance.
    2- cons : expensive, GIT side effects, sbo, GI perforation, fecal impaction accumulation in liver

  • Elsayed Ghorab


    Why is it hard for most patients to achieve target phosphate levels?

  • Weam El Nazer


    1-Phosphate binders began with the 1970s-introduced 1-aluminum salts. In the GI tract, aluminum salts form coordination compounds with phosphate ions, yielding insoluble aluminum phosphate precipitates. Aluminum-based phosphate binders were successful, but osteomalacia and anemia caused their discontinuation.
     
    2- Calcium-based phosphate binders were introduced in the mid-1980s to replace aluminum-based ones.
     
    They were effective, cheap, and extensively used when first launched.
     
    However, calcium-based binders may cause arterial calcification and increase CV mortality.
     Calcium-based binders enhance vascular calcification and arterial stiffness.
    3-Calcium acetate/magnesium carbonate in an animal model assessed magnesium’s potential impact on bone turnover and mineralization.
    29 Calcium acetate/magnesium carbonate decreased vascular calcification without affecting bone remodeling or magnesium levels.
     
    4- sevelamer reduced phosphorus without increasing the calcium burden.
     
     A Cochrane systematic review of phosphate binders indicated that sevelamer may reduce all-cause mortality in dialysis patients. Sevelamer carbonate was created because sevelamer hydrochloride worsened metabolic acidosis33.
    5-Lanthanum carbonate, licensed in 2004, reduces phosphorus levels without increasing calcium load. possibly reducing treatment-related hypercalcemia.
     Lanthanum’s prescription instructions warn of significant GI blockage, ileus, GI perforation, and fecal impaction.
     
    6- Ferric citrate and sucroferric hydroxide bind 6-iron. 2013 authorized sucroferric hydroxide. It lowers phosphorus levels in dialysis patients with fewer pills than sevelamer carbonate. 2014 authorized ferric citrate. A meta-analysis of 16 trials found ferric citrate to decrease phosphorus and phosphorus-calcium product better than no active treatment and equivalent to other phosphate binders. However, the drug produced more GI side effects.
     

  • Emad mohamed mokbel Salem


    Summarize the pros and cons of common phosphate binders overtimecalcium based phosphate binders:
    pros:
    1-effective
    2-inexpensive
    3-widely used
    cons:
    1-vascular calcification(increase calcium load)
    2-increase cv mortality
    3-increase arterial stifness
    ============
    aluminum based phosphate binder:
    pros:
    1-effective
    2-not associated with hypercalcemia

    cons:
    risk of aluminum toxicity
    =========
    sevelamer HCL:
    pros:
    1-decrease serum phosphorous without increase serum calcium

    cons
    worsen metabolic acidosis
    ============
    lanthanum carbonate :
    pros:
    decrease serum phosphorous without increase serum calcium
    cons:
    GI obstruction ,ileus ,perforation and faecal impaction
    expensive

  • Nour Al Natout


    Calcium-based binders (such as calcium acetate and calcium carbonate):

    Pros:
    Relatively inexpensive.

    Are safe and well-tolerated.

    Cons:

    May increase the risk of hypercalcemia and vascular calcification, kidney stones with long-term use.

    Aluminum-based binders:
    Pros:
    Very very effective in lowering phosphate levels. ( In my experience the most effective).
    Inexpensive.

    Cons:
    risk of aluminum accumulation in CNS, Bone , Bone marrow.
    May cause constipation.

    Sevelamer ( sevelamer carbonate and sevelamer hydrochloride):
    Pros:

    May reduce the risk of cardiovascular events. The ost effective in decreasing fgf23 level (-30 precent).

    Cons:

    More expensive
    Gastrointestinal side effects .

    Lanthanum carbonate:
    Pros:
    May reduce the risk of cardiovascular events. The ost effective in decreasing fgf23 level (-30 precent).

    Cons:
    More expensive than calcium-based binders.
    Gastrointestinal side effects like nausea, vomiting, and diarrhea.

  • Ibrahim Omar


    Summarize the pros and cons of common phosphate binders overtime.

    • calcium-based phosphate binders :

    1- pros : inexpensive.
    2- cons : +ve calcium balance and vascular calcification.

    • Aluminum based phoshate binders

    1- pros : inexpensive, no effect on calcium balance.
    2- Cons : Aluminum toxicity with anemia, dementia, adynamic bone disease.

    • Sevelamer :

    1- pros : no effect on calcium balance.
    2- cons : expensive, unpalatable, GIT side effects

    • Lanthunum :

    1- pro : no effect on calcium balance.
    2- cons : expensive, GIT side effects, accumulate in liver

  • Ben Lomatayo


    Summarize the pros and cons of common phosphate binders overtime.
    All are effective in reducing phosphate levels and associated with significant side effects, the differences comes in terms pills burden. The newer ones such as iron-based may have less pills burden

    1.Almnium-based binders in 1970s

    • cognitive disorders
    • Osteomalacia
    • Anemia

    2.Calcium-based binders in 1980s

    • Vascular calcification
    • Arterial stiffness

    3.Magnesium-based binders in1980s

    • High magnesium
    • Diarrhea

    4.Sevelamer hydrochloride/Carbonate in 2000

    • Vomiting
    • Nausea
    • Ileus
    • Fecal impaction
    • Bowel perforation
    • Bowel perforation

    5.Lanthanum carbonate in 2004

    • Ileus
    • Fecal impaction
    • Bowel perforation
    • Bowel perforation
    • Accumulation in the liver

    6.Iron-based 2013/2014

    • Nausea
    • Vomiting
    • cough
    • Discolored stool
    • Diarrhea
    • Constipation
    • Abdominal pain

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