ABSTRACT
Controlling serum phosphorus levels is critical in patients with renal failure. Currently phosphate-binding agents are widely used to reduce phosphate absorption in patients with end-stage renal disease. If possible, serum phosphorus level should be reduced without disturbing calcium homeostasis or increasing accumulation of potentially toxic elements. Aluminum hydroxide and traditional calcium-based phosphate binders are commonly used to control serum phosphorus level. Aluminum hydroxide can effectively lower serum phosphorus level, but aluminum can accumulates in the body and results in toxic effect. Traditional calcium-based phosphate binders tend to promote hypercalcemia and calcium overloading, and accelerate cardiovascular calcification. Therefore aluminum-free and calcium-free phosphate-binding agents have become the focus of study; however, agents like sevelamer hydrochloride and lanthanum carbonate are not widely used due to high price, although they are effective in controlling serum phosphorus level. New generation of phosphate binders, such as colestilan, nicotinic acid and magnesium salt, are cheaper than their previous counterparts, but their long-term effect still needs to be observed. This article summarizes the progress of non-calcium phosphate binders in treatment of end-stage renal diseases, hoping to help clinical drug usage.