The Medical Letter on Drugs and Therapeutics
Phosphate Binders
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Hyperphosphatemia in end-stage renal disease can lead to secondary hyperparathyroidism, renal osteodystrophy, metastatic calcification and cardiovascular mortality. In addition to dietary restriction of phosphorus and hemodialysis, drugs that bind phosphates in the gut are usually needed as well. Aluminum hydroxide is no longer recommended for long-term use because of concerns about its toxicity.1,2

CALCIUM CARBONATE — The usefulness of calcium carbonate (Os-Cal, and others) as a phosphate binder is limited by its insolubility at a high gastric pH, which is often present in end-stage renal disease. It can cause gastrointestinal (GI) discomfort and hypercalcemia, which could lead to arterial calcification and possibly cardiac death.3

CALCIUM ACETATE — Compared to calcium carbonate, the solubility and phosphate-binding capacity of calcium ... more      

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