Contemporary opportunities for using phosphate binders in dialysis patients
Hyperphosphatemia in patients with chronic kidney disease (CKD) undergoing hemodialysis is associated with a high risk of cardiovascular morbidity and mortality. Controlling serum phosphorus has long been recognized as one of the key objectives in managing CKD patients. The main strategies in preventing and managing hyperphosphatemia are hypophosphorous diet, adequate dialysis and the use of phosphate binders. The article reviews the most commonly used phosphate binders. It discusses the pharmacokinetics, side effects, initial and maintenance doses, phosphate-binding capacity and contraindications for phosphate binders. New approaches to monitoring the serum phosphorus level in CKD patients undergoing dialysis are presented. The review describes the principles of administering phosphate binders based on their efficacy and tolerability, and considering the phosphorus load, comorbidities and contraindications. The authors present an algorithm and the results of the comparative assessment of the phosphate-binding capacity of phosphate binders based on using relative phosphate binding ratio and phosphate-binding equivalent dose to facilitate selecting the dosage of phosphate binders. High phosphate-binding capacity of phosphate binders improves the effectiveness of correcting hyperphosphatemia, decreases the medication load and improves patient's adherence to the prescribed therapy.