Table 1.

Advantages and disadvantages of clinically tested phosphate- and fibroblast growth factor receptor 23 (FGF23)-lowering therapies.

Class of drug	Drug	Advantages	Disadvantages
Non-calcium phosphate binders	Sevelamer	Lower intact FGF23 and urinary Pi secretion, hypolipidemic [150,151,152]	GI side effects, high pill burden, unchanged serum Pi [150,151,152]
	Lanthanum carbonate	Good GI tolerance, lower C-term FGF23 [154]	Unchanged serum Pi and intact FGF23 [151,155,160], low solubility: tissue accumulation might cause long-term toxicity
	Ferric citrate	Lower serum Pi and intact FGF23, increase hemoglobin and ferritin [153,157,158]	Mild GI side effects [153,157,158]
Calcium-based phosphate binders	Calcium carbonate/acetate	Controlled [150,151] or lower [161] serum Pi	Hypercalcemia, VC, unchanged or increased intact FGF23 [150,151]
Nicotinamide		Lower serum Pi and intact FGF23 in dialysis patients [162,163,164]	Unchanged serum Pi and intact FGF23 in non-dialysis patients [160], mild GI side effects, at high doses hepatotoxic/thrombocytopenia [162,163,164,165,166]
Magnesium supplements	Oral magnesium oxide	Slower progression of VC [167]	Unchanged serum Pi, FGF23 not measured, Mild GI side effects [167]
	Higher dialysate magnesium	Increased conversion time from primary CPP to secondary CPP (T50 test, lower serum Pi [168]	Unchanged serum Pi, FGF23 not measured [168]
Pi-transporter inhibitor	NaPi-2b inhibitor		Not effective in reducing serum Pi [169]

GI, gastrointestinal; VC, vascular calcification; CPP, calciprotein particles; NaPi-2a, type IIa/b sodium-dependent phosphate transporter.