The Effect of Aluminium Hydroxide on Calcium, Phosphorus and Aluminium Balances and the Plasma Parathyroid Hormone in Patients with Chronic Renal Failure

An Update on Phosphate Binders: A Dietitian's Perspective

“…Additionally, there is evidence that overexposure to calcium can contribute to metastatic calcification. 4,5,14,26 The recommended starting dose for the PhosLo gelcaps (667 mg) and tablets is 2 gelcaps per meal and 10 mL (667 mg/5 mL) per meal for Phoslyra. 14,34 Noncalcium/Nonmetal Binders Sevelamer hydrochloride (Renagel Ò , Sanofi US, Bridgewater, NJ), and sevelamer carbonate (Renvela Ò , Sanofi US, Bridgewater, NJ) are the two products currently available in this class.…”

“…For the 185 participants in the ferric citrate arm, the median aluminum level was 6.0 (5-24, range) mg/L at baseline and 7.0 (5-23, range) m/L at week 52. For the active control arm, baseline levels were 6.0 (5-14) m/L and 6.0 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) m/L at week 52. Researchers concluded that there were no meaningful changes in aluminum levels observed in the study between either group (P 5.1).…”

“…Phosphate-binding compounds were introduced in the 1970s for the treatment of hyperphosphatemia in patients on dialysis after it was observed that oral administration of aluminum hydroxide as an antacid also reduced serum PO 4 levels. 5 Forty years later, aluminum is almost never used as a phosphate binder as many other safer compounds are now available. Calcium-based binders (calcium bicarbonate and calcium acetate) became the binder of choice in the 1980s and 1990s.…”

Aluminum in the Environment and Human Health

“…Interestingly, in chronic renal failure, Al(OH):, is the agent of choice for the prophylaxis of hyperphosphatemia (341,346).…”

“…The periorbital bleeding could not be independently reproduced by Thurston et al (344,345), and they suggested it was the result of a possible local infection. Failure to confirm the originally reported toxicity (509,510) suggested that elimination of AI(OH)3 from therapeutic use in the treatment of renal disease was unwarranted, according to Bailey et al (341), Sherrard (343), and Thurston et al…”