Tags

Type your tag names separated by a space and hit enter

Use of phosphate binders in chronic kidney disease.
Curr Opin Nephrol Hypertens. 2013 Jul; 22(4):413-20.CO

Abstract

PURPOSE OF REVIEW

Hyperphosphatemia is a paradigmatic finding in late-stage chronic kidney disease (CKD) and consistently associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causative role of hyperphosphatemia for cardiovascular complications, especially with regard to vascular, valvular and soft-tissue calcifications, and for subsequent mortality. Therefore, phosphate management is thought to play a pivotal role in health and longevity of CKD patients. In this regard, phosphate binders are considered the prime option; however, dietary phosphate restriction and intensified dialysis are also valuable supportive tools.

RECENT FINDINGS

Studies on available calcium-free phosphate binders demonstrate potential to interfere with phosphate regulatory factors, such as fibroblast growth factor-23 (FGF23). Magnesium-containing phosphate binding may possess a pleiotropic potential due to its calcification inhibitory properties. Novel phosphate lowering compounds, including colestilan, iron-containing binders and nicotinamide, are underway to extend the armamentarium of phosphate-lowering strategies. An open question remains when to therapeutically counteract phosphate retention by binders. A recent prospective randomized trial in patients with moderate CKD (stages 3b-4) and phosphate levels in the upper normal range demonstrated only moderate reductions in serum phosphate levels, no effects on FGF23, but increased vascular calcification progression with active treatment versus placebo. Another small trial in patients with similar renal function given diets containing approximately 1 g of calcium and 1.4 g of phosphate per day showed neutral calcium and phosphate balances, whereas addition of calcium carbonate as a phosphate binder only caused a positive calcium, but no negative phosphate balance.

SUMMARY

Adequate phosphate management in end-stage CKD remains a mainstay of our therapeutic approaches in this population, and additional promising drugs are in development and may shortly be available. The timing and indication for phosphate-lowering strategies in predialysis CKD is currently unclear.

Authors+Show Affiliations

Division of Nephrology, Klinikum Coburg GmbH, Coburg, Germany. markus.ketteler@klinikum-coburg.deNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23736841

Citation

Ketteler, Markus, and Patrick H. Biggar. "Use of Phosphate Binders in Chronic Kidney Disease." Current Opinion in Nephrology and Hypertension, vol. 22, no. 4, 2013, pp. 413-20.
Ketteler M, Biggar PH. Use of phosphate binders in chronic kidney disease. Curr Opin Nephrol Hypertens. 2013;22(4):413-20.
Ketteler, M., & Biggar, P. H. (2013). Use of phosphate binders in chronic kidney disease. Current Opinion in Nephrology and Hypertension, 22(4), 413-20. https://doi.org/10.1097/MNH.0b013e32836214d4
Ketteler M, Biggar PH. Use of Phosphate Binders in Chronic Kidney Disease. Curr Opin Nephrol Hypertens. 2013;22(4):413-20. PubMed PMID: 23736841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of phosphate binders in chronic kidney disease. AU - Ketteler,Markus, AU - Biggar,Patrick H, PY - 2013/6/6/entrez PY - 2013/6/6/pubmed PY - 2014/1/11/medline SP - 413 EP - 20 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 22 IS - 4 N2 - PURPOSE OF REVIEW: Hyperphosphatemia is a paradigmatic finding in late-stage chronic kidney disease (CKD) and consistently associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causative role of hyperphosphatemia for cardiovascular complications, especially with regard to vascular, valvular and soft-tissue calcifications, and for subsequent mortality. Therefore, phosphate management is thought to play a pivotal role in health and longevity of CKD patients. In this regard, phosphate binders are considered the prime option; however, dietary phosphate restriction and intensified dialysis are also valuable supportive tools. RECENT FINDINGS: Studies on available calcium-free phosphate binders demonstrate potential to interfere with phosphate regulatory factors, such as fibroblast growth factor-23 (FGF23). Magnesium-containing phosphate binding may possess a pleiotropic potential due to its calcification inhibitory properties. Novel phosphate lowering compounds, including colestilan, iron-containing binders and nicotinamide, are underway to extend the armamentarium of phosphate-lowering strategies. An open question remains when to therapeutically counteract phosphate retention by binders. A recent prospective randomized trial in patients with moderate CKD (stages 3b-4) and phosphate levels in the upper normal range demonstrated only moderate reductions in serum phosphate levels, no effects on FGF23, but increased vascular calcification progression with active treatment versus placebo. Another small trial in patients with similar renal function given diets containing approximately 1 g of calcium and 1.4 g of phosphate per day showed neutral calcium and phosphate balances, whereas addition of calcium carbonate as a phosphate binder only caused a positive calcium, but no negative phosphate balance. SUMMARY: Adequate phosphate management in end-stage CKD remains a mainstay of our therapeutic approaches in this population, and additional promising drugs are in development and may shortly be available. The timing and indication for phosphate-lowering strategies in predialysis CKD is currently unclear. SN - 1473-6543 UR - https://www.unboundmedicine.com/medline/citation/23736841/Use_of_phosphate_binders_in_chronic_kidney_disease_ L2 - https://doi.org/10.1097/MNH.0b013e32836214d4 DB - PRIME DP - Unbound Medicine ER -