Phosphate binders, past – present – future. A critical appraisal.

Malindretos, Pavlos; Cozzolino, Mario

doi:10.1517/14656566.2016.1133593

Cited by 7 publications

(8 citation statements)

References 19 publications

(17 reference statements)

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“…Aluminum salts, introduced in the 1970s, were the first phosphate binders. 13,14 (Figure 1) Aluminum salts reduce phosphate availability by forming coordination compounds with phosphate ions, creating insoluble aluminum phosphate precipitates in the gastrointestinal (GI) tract. 15 Although effective, the use of aluminum-based phosphate binders was largely discontinued in the 1980s due to an association with neurotoxicity, 16 cognitive disturbances, osteomalacia, and anemia.…”

Section: Evolution Of Phosphate Management Therapiesmentioning

confidence: 99%

Past, Present, and Future of Phosphate Management

Doshi

Wish

2022

Kidney International Reports

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Section: Evolution Of Phosphate Management Therapiesmentioning

confidence: 99%

Past, Present, and Future of Phosphate Management

Doshi

Wish

2022

Kidney International Reports

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“…High phosphate levels have been consistently associated with unfavorable outcomes in patients with CKD, but several limitations hamper a definition of the optimal targets of phosphate serum levels (12). Nonetheless, hyperphosphatemia is a late marker of phosphate overload.…”

Section: What Phosphate Target Should Be Pursued?mentioning

confidence: 99%

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Bellizzi

Carrero

Chauveau

et al. 2016

Nephrology @ Point of Care

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This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2 nd International Conference of the European Renal Nutrition working group at ERA-EDTA-"Retarding CKD progression: readily available through comprehensive nutritional management?"-and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD)• What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed?• Is a body mass index (BMI) of 21 kg/m 2 adequate? • What phosphate target should be pursued?• What are the nutritional habits in patients with incident CKD?• What protein needs and amount of dietary protein should be pursued?• Does the quality of protein matter?• What amount of dietary salt should be employed? How should this be obtained?• How should normal serum phosphate be achieved?• What diet should be recommended? Is a vegetarian diet an option?

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“…Sevelamer was the first polymer developed as a P binder for patients with CKD, and there is now >20 years of clinical experience in its use within the context of a multiple therapeutic approach to CKD-MBD (including vitamin D, calcimimetics and/or Ca supplements) [35, 36]. Sevelamer carbonate (instead of hydrochloride) was subsequently developed mainly because patients with CKD are already predisposed to developing metabolic acidosis.…”

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Small steps towards the potential of ‘preventive’ treatment of early phosphate loading in chronic kidney disease patients

Bover

Cozzolino

2019

Clinical Kidney Journal

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Few clinical studies have investigated the value of phosphate (P)-lowering therapies in early chronic kidney disease (CKD) patients in whom hyperphosphataemia has not yet clearly developed and they report conflicting and even unexpected results. In this issue of Clinical Kidney Journal, de Krijger et al. found that sevelamer carbonate (4.8 g/day for 8 weeks) did not induce a significant reduction of pulse wave velocity (PWV) and that fibroblast growth factor 23 (FGF23) did not decrease despite a decline in 24-h urine P excretion. To some extent these findings challenge the concept that ‘preventive’ P binder therapy to lower FGF23 is a useful approach, at least over this short period of time. Interestingly, in a subgroup of patients with absent or limited abdominal vascular calcification, treatment did result in a statistically significant reduction in adjusted PWV, suggesting that PWV is amenable to improvement in this subset. Interpretation of the scarce and heterogeneous observations described in early CKD remains difficult and causality and/or the possibility of ‘preventive’ treatment may not yet be completely disregarded. Moreover, de Krijger et al. contribute to the identification of new sources of bias and methodological issues that may lead to more personalized treatments, always bearing in mind that not all patients and not all P binders are equal.

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Phosphate binders, past – present – future. A critical appraisal.

Cited by 7 publications

References 19 publications

Past, Present, and Future of Phosphate Management

Past, Present, and Future of Phosphate Management

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Small steps towards the potential of ‘preventive’ treatment of early phosphate loading in chronic kidney disease patients

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