ABSTRACT

An increase in the serum phosphorus concentration has been reported to be an independent risk factor for deaths in patients with chronic kidney disease and end-stage renal disease on dialysis. As kidney function declines, modification of the serum phosphorus by dietary means becomes increasingly difficult without simultaneously inducing a state of protein deficiency. Consequently, there is a need to selectively reduce intestinal phosphorus absorption as efficiently as possible. This has led to the use of various phosphorus-binding agents each with different characteristics. To understand the utility and relative potency of these agents, it is useful to briefly consider the factors controlling intestinal phosphorus absorption and to describe the features that distinguish one binding agent from another. The latest developments in the regulation of serum phosphorus in chronic renal failure are presented here.