Table 1.

Comparison of the Currently Available Phosphate Binders

Binder	Advantages	Disadvantages	Forms	Dosage (mg)
Calcium Carbonate	Effective Inexpensive Readily available (over the counter) Long-term experience	Potential hypercalcemia Potential for progression of vascular calcification GI side effects Low-turnover bone disease	Tablet, chewable Capsule Liquid Gum	Contains 40% elemental calcium (200mg elemental calcium per 500mg)
Calcium Acetate	Effective Inexpensive Readily available Long-term experience Potentially less calcium absorption than calcium carbonate	Potential hypercalcemia Potential for progression of vascular calcification GI side effects Low-turnover bone disease	Tablet Capsule Liquid	Contains 25% elemental calcium (160mg elemental calcium per 667 mg capsule) Total dose of elemental calcium should not exceed 2,000–2,500 mg/day
Magnesium Carbonate/Calcium Acetate	Effective Inexpensive Decreased calcium load compared with calcium-based binders	Potential hypermagnesemia Potential hypercalcemia GI side effects No long-term experience	Tablet	235 mg/435 mg Maximum dose is 3–6 pills/day
Aluminum hydroxide	Very effective Inexpensive	Potential for aluminum toxicity GI side effects Altered bone mineralization Anemia	Tablet Capsule Liquid	300–600 mg 3 times per day Aluminum content varies from 100 to >200 mg per tablet Limit use to no more than 4 weeks
Lanthanum Carbonate	Effective Calcium free	Expensive Potential for lanthanum accumulation in bone and tissue GI side effects No long-term data	Tablet, Chewable Powder	500–1,000 mg (3–6 chewable tablets) 3 times per day
Sevelamer hydrochloride	Effective Calcium free Pleiotropic effects	Expensive GI side effects Metabolic acidosis Potential interferes with vitamin D and vitamin K absorption Potentially decreased vascular calcification	Tablet	800–1600 mg 3 times per day Maximum dose studied 13 grams/day
Sevelamer Carbonate	Effective Calcium free Pleiotropic effects No metabolic acidosis	Expensive GI side effects Potential interferes with vitamin D and vitamin K absorption Potentially decreased vascular calcification	Tablet Powder	800–1600 mg 3 times per day Maximum dose studied 14 grams/day
Sucroferric Oxyhydroxide	Effective Calcium free Less pill burden than sevelamer Potential to raise transferrin, iron and hemoglobin levels	Expensive GI side effects Cannot be prescribed with oral levothyroxine or paricalcitol Long-term side effects unknown Unknown if iron accumulation long-term	Tablets, chewable	500 mg (1 tablet) 3 times per day Maximum dose is 3,000 mg/day
Ferric Citrate	Effective Calcium free Less pill burden than sevelamer Potential to raise transferrin, iron and hemoglobin levels Potential to decrease iron and ESA usage	Expensive GI side effects Long-term side effects unknown Unknown if iron accumulation long-term	Tablets	Each tablet contains 210 mg ferric iron Starting dose: 2 tablets 3 times per day Maximum dose is 12 tablets per day

Mg= milligrams; GI= gastrointestinal; ESA= erythropoietin stimulation agents