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 |