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