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Table 1 Summary of the advantages and disadvantages of different phosphate binders

From: Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia

Phosphate binder Advantages Disadvantages (limiting factors)
Calcium acetate
(e. g. Calcium acetate Nefro®, Calcium acetate Prorenal AM®, Phos-Ex®, amongst others)
• Effectiveness independent of pH value
• Lower calcium uptake compared to calcium carbonate
• Moderate tablet burden
• Highly cost-effective
• Good tolerability
• Gastrointestinal complaints
• Risk of hypercalcaemia
• In some circumstances, influence on vascular calcification
Calcium carbonate
(e. g. CC-Nefro®, Dreisacarb®, Calci-Gry®, amongst others)
• Effective
• Highly cost-effective
• Good tolerability
• Effectiveness influenced by pH value
• Gastrointestinal complaints
• Risk of hypercalcaemia
• In some circumstances, influence on vascular calcification
Aluminum salts
(e. g. Phosphonorm®)
• High effectiveness independent of pH value
• Highly cost-effective
• High risk of aluminum toxication including encephalopathy and bone diseases
• Difficulties in relation to precise dosing
• Greater amount of controls
Sevelamer
(Renagel®, Renvela®)
• Effective
• No risk of hypercalcaemia
• Amongst other things, preventative action in relation to calcification and cholesterol
• Frequent gastrointestinal complaints
• High costs
• High tablet burden, poor compliance
• In some circumstances, negative influence on other medication (e.g. binding of fat-soluble vitamins)
Lanthanum carbonate
(Fosrenol®)
• Effectiveness independent of pH value
• No risk of hypercalcaemia
• Low dosage - low tablet burden, improved compliance
• High costs
• In some circumstances, lanthanum particles can be reabsorbed from the intestine and reach the organs
Combination preparation
(OsvaRen®)
• Effectiveness independent of pH value
• Lower calcium uptake and reduced risk of hypercalcaemia compared to calcium acetate and calcium carbonate
• Good tolerability
• Moderate tablet burden
• Moderate costs
• In some circumstances, preventative effect in relation to calcification
• Monitoring of the magnesium level
• In some circumstances, moderate increase in the serum magnesium level