Phosphate binders in patients with chronic kidney disease

Hyperphosphataemia in patients with chronic kidney disease, particularly those on dialysis, can be ameliorated by oral phosphate binders in conjunction with dietary phosphate restriction. Although phosphate binders reduce serum phosphate in these patients, it remains uncertain whether they improve clinical outcomes. Calcium-based binders are frequently used, but their popularity is waning due to emerging evidence of accelerated vascular calcification. The use of aluminium-based binders has been limited by a perceived risk of aluminium accumulation. The non-calcium-based phosphate binders - sevelamer hydrochloride, lanthanum carbonate and sucroferric oxyhydroxide - have become available and subsidised by the Pharmaceutical Benefits Scheme for patients on dialysis. The pill burden and adverse effects (particularly gastrointestinal intolerance) associated with phosphate binders often contribute to poor medication adherence.