Calcium and phosphorus management in chronic kidney disease: Challenges and trends

Common and serious comorbidities in chronic kidney disease include bone and mineral disorders, especially hyperphosphatemia and secondary hyperparathyroidism, and cardiovascular calcification and cardiovascular disease. Managing these complications typically requires the use of phosphate-binding compounds and vitamin D analogues. The selection and use of phosphate-binding agents in particular requires careful consideration of various factors such as calcium load and increased risk of subsequent cardiovascular calcification. Currently available calcium-containing phosphate binders have been demonstrated to contribute to patient calcium loads, and their use in hemodialysis patients has been associated with significant and progressive cardiovascular calcification. Thus, there is increasing interest in the use of calcium-free products, which can effectively bind phosphate without enhancing the risk for cardiovascular calcification.