Treating hyperphosphatemia – current and advancing drugs

ABSTRACT

Introduction: Hyperphosphatemia is a hallmark of advanced chronic kidney disease (CKD) and associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causal relationship between hyperphosphatemia and mortality as well as cardiovascular complications, especially including vascular, valvular and soft-tissue calcifications. Thus, appropriate phosphate lowering is considered to play a major role in health and longevity of CKD patients. In this respect, phosphate binders are the most powerful therapeutic option, while dietary phosphate restriction and intensified dialysis are valuable supportive approaches.

Areas covered: Pubmed was the primary research platform. This search focused on novel phosphate lowering compounds, including iron-containing binders and phosphate transport inhibitors, which have just become available or are in the approval process. Further, additional reports on effective strategies to counteract the adverse consequences of resistant hyperphosphatemia were also collected.

Expert opinion: New iron-containing drugs may offer advantages, including iron supplementation, low pill burden and high efficacy. Phosphate transport inhibitors possess a high potential as add-on compounds in patients with insufficient phosphate binder therapy. One unsolved question remains at what CKD stage to start therapeutically counteracting phosphate retention.

KEYWORDS:

• Hyperphosphatemia
• FGF23
• calcification
• sevelamer
• lanthanum
• phosphate binders
• sucroferric oxyhydroxide
• ferric citrate
• nicotinamide
• tenapanor

Declaration of interest

M Ketteler has received honoraria for roles as a speaker and/or advisor to MEDICE Pharma, Sanofi, Shire and Vifor Fresenius Medical Care Renal Pharma. P H Biggar has received honoraria from Vifor Fresenius Medical Care Renal Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.