Table 3.

Pharmacologic Interventions for the Management of Hyperphosphatemia

Class	Name	Mechanism	Advantages	Disadvantages
Calcium containing binders	Calcium carbonate, calcium phosphate	Calcium combines with phosphate in the bowel and excreted as insoluble complex in the feces	Low cost	Potential risk of hypercalcemia, adynamic bone disease, and vascular calcification
Non-calcium-containing binders	Sevelamer carbonate or hydrochloride	Cationic polymers that bind phosphate in the intestine through ion exchange	Avoids positive calcium balance	Cost, pill burden. Sevelamer hydrochloride might induce metabolic acidosis
	Lanthanum carbonate	Phosphate binding in the gastrointestinal tract	Avoids positive calcium balance. Chewable, less pill burden	Cost
Other mechanism	Sucroferric oxyhydroxide, ferric citrate	Phosphate binding in the gastrointestinal tract	Avoids calcium, relatively less pill burden, small iron absorption	Cost
	Nicotinamide	Decreases sodium-dependent phosphate transporter in the intestine		Intolerance (flushing)
	Tenapanor	Inhibitor of intestinal sodium/hydrogen exchanger 3 (NHE3), reduce paracellular phosphate transport in the intestine	Inhibits principal route of phosphate absorption, potentially less pill burden	Diarrhea, cost
	Aluminum hydroxide	Phosphate binding in the gastrointestinal tract	Low cost	Rarely used chronically dueto riskof aluminum exposure in patients with CKD