Calcium-Based Phosphate Binders Are Appropriate in Chronic Renal Failure

Abstract

Many nephrologists feel threatened by the allegation that, in patients with chronic renal failure, treatment with calcium-based phosphate binders (calcium acetate and calcium carbonate) may induce coronary artery and cardiac calcification, thereby imposing a greater risk for death compared with sevelamer, a non–calcium-based binder. Acknowledging that drug manufacturers are not unaware of the marketing advantage to their product consequent to destabilizing demand for competing drugs, the case for and against abandoning calcium-based phosphate binders in favor of sevelamer is reviewed in this study. The case for continuing prescription of calcium-based phosphate binders stands on the following: (1) flawed clinical trials that favor sevelamer as a replacement; (2) weak evidence that oral calcium intake modulates vascular and/or cardiac calcification; (3) clinical trials that reinforce the safety and efficacy of calcium-based phosphate binders; and (4) the inordinate relative cost of sevelamer. Recognizing that established as well as novel phosphate binders are currently undergoing clinical evaluation, an open mind and an awareness of developing literature are necessary when deciding how to manage hyperphosphatemia in renal failure.