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Types of Phosphorus Binders

Phosphorus is a mineral needed to build strong bones and teeth, deliver oxygen to tissues, aid in energy use and help maintain a normal pH. Too much phosphorus can cause problems with the bones and heart. Healthy kidneys remove extra phosphorus, but those with kidney problems cannot maintain proper levels of the mineral. People with kidney disease should limit their phosphorus intake. Dialysis patients often take phosphate binders, which "bind" to the phosphorus and make it unable to be absorbed. There are four common types of these binders.

  1. Aluminum-Based Binders

    • Aluminum hydroxide was the first type of phosphorus binder used. Aluminum-based binders are very effective, but can have toxic side effects. There is a potential for aluminum toxicity as well as a risk of dementia, gastrointestinal side effects and altered bone mineralization. Aluminum-based binders are rarely prescribed for long-term use and are sometimes given short-term when other binders are not working.

    Calcium-Based Binders

    • Calcium-based phosphate binders are another common form and have largely replaced aluminum-based binders. Although not as effective as aluminum-based binders, calcium-based binders can act as a calcium supplement as well. Tums, made from calcium carbonate, is commonly used. Phosphorus binders must be taken with meals, and often several binders must be taken at each meal. There is a risk of absorbing too much calcium, which can lead to organ damage, so calcium levels must be closely monitored if taking a calcium-based binder.

    Aluminum-Free, Calcium-Free Binders

    • A third type of phosphorus binder contains no aluminum or calcium. One common brand name is Renagel. These newer binders are effective at controlling phosphorus levels and carry no risk of elevated aluminum or calcium in the blood. The source of the binder is sevelamer, which does not contain calcium or metal. The binder mixes with phosphorus in the intestinal tract to remove any excess. These binders are more expensive and might require additional calcium supplementation. There is also a risk of gastrointestinal side effects.

    Magnesium-Based Binders

    • Magnesium-based phosphorus binders are used as an alternative to calcium-based binders for patients who require a lower calcium intake. There is a potential for too much magnesium to accumulate in the blood and cause lethargy, nausea, vomiting and slurred speech. Therefore, magnesium levels should be monitored if taking this type of binder. Magnesium-based binders may be appropriate for peritoneal dialysis patients because these patients tend to have lower magnesium levels.

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