Oral Phosphate Binders

Because of poor phosphate removal with dialysis, the use of Al or calcium phosphate binders has been required for lowering serum phosphate levels in uremic patients. A prospective, controlled study of pediatric patients 

---

Aluminum intoxication was first implicated in this disorder by Alfrey and associates (Alfrey et al., 1976). The aluminum content of brain gray matter was elevated to eleven times the normal value in patients with dialysis dementia, versus an increase of three times the normal in patients on chronic hemodialysis without dialysis dementia. Aluminum content was also increased in bone and other soft tissue. Oral phosphate binders containing aluminum [AKOHlj and AljlCOj) ] were originally suspected to be the source of the aluminum. 

CRD precipitates hyperphosphatemia that was treated with a novel iron-based oral phosphate binder, ferric citrate hydrate (TT-751 KRX-0502) with high efficacy and safety [116 , 117 ]. 

Adverse effects of calcium-containing phosphate binders, as well as sevel-amer and lanthanum, include constipation, diarrhea, nausea, vomiting, and abdominal pain. The risk of hypercalcemia is also a concern. To avoid potential drug interactions, phosphate binders should be administered 1 hour before or 3 hours after other oral medications. 

A 59-year-old man presented with end-stage renal insufficiency. While on hemodialysis he had used aluminium hydroxide as a phosphate binder but then used calcium lactate instead after total parathyroidectomy. Oral vitamin D was discontinued after the parathyroidectomy. However, after he had received a renal transplant he developed aluminium-related bone disease and was treated with infusions of deferoxamine. 

A 10-year-old boy with terminal renal insnfficiency and secondary hyperparathjroidism was treated with calcitriol (0.5 mg/day 0.02 mg/kg). His semm calcinm rose to 3.05 mmol/1 with a parathyroid hormone concentration of 51 pg/ml (reference range 15-65 pg/ml the target range is 2-4 times higher). Calcitriol was withdrawn, hemodialysis was performed, and oral calcium acetate 2 g/day was administered as a phosphate binder. His calcium returned to normal after 4 months. 

Aluminum toxicity has also been linked with oral exposure as a result of Al-containing pharmaceutical products such as Al-based phosphate binders or antacid intake. As over-the-counter antacids are an important source for human Al exposure from a quantitative point of view, patient information leaflets in Europe contain warnings of possible Al toxicity. ... 

---