Settembre Ottobre 2018 - In depth review

Hyperphosphatemia in dialysis: which binder?


Several studies have evidenced the association between high serum phosphorus concentrations and adverse events especially in patients on dialysis.

Recent K-DIGO guidelines suggest lowering elevated phosphate levels toward the normal range. This goal should be achieved by combining dietary counseling, optimizing dialysis procedures and prescribing phosphate binders.

Despite the availability of several binders, the “ideal” phosphate binder that combines high efficacy, low pills burden, minimal side effects and low cost is still not available.
In clinical practice it is crucial to reach a high patient’s compliance to therapy. The pill burden is the most relevant factor contributing to low compliance. This is the case of phosphate binder therapy that represents almost 50% of total pills prescribed to patients on dialysis.
It has been evidenced an association between pills of phosphate binder and poor control of phosphorus and PTH.
In recent years sucroferric oxyhydroxide is available as a new phosphate binder. Its
peculiarity is an high phosphate binding capability that requires prescription of low number of pills per day. This characteristic has been confirmed by several randomized controlled trials. These trials have also evidenced that sucroferric oxyhydroxide may cause some gastrointestinal side effects. There is an ongoing study to confirm in “the real world” the incidence of side effects reported by controlled trials.

Key words: Phosphate; Binder; Secondary Hyperparathyroidism

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Lo scenario attuale

Le alterazioni del metabolismo minerale, ed in particolare l’iperfosforemia, sono riconosciute oggi fattori di rischio importanti per l’incremento della morbilità e mortalità dei pazienti affetti da malattia renale cronica, sia durante le fasi iniziali che nelle fasi più avanzate di malattia (1, 2).  Il controllo del bilancio fosforico rappresenta pertanto un punto cardine nel trattamento di questi pazienti.


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