Drug treatment of phosphate-calcium metabolism disorders in patients with chronic kidney disease and mineral and bone disorder

Main Article Content

Y.O. Dombrovsky
M.D. Ivanova
D.D. Ivanov


Changes in phosphate-calcium metabolism commonly occurred in patients with chronic kidney disease and are a major pathogenetic factor in the development of secondary hyperparathyroidism and mineral and bone disorder in this group of patients. This article is mainly devoted to a review of basic drugs for CKD-MBD therapy, in particular, Sevelamer and Cinacalcet.

Article Details

How to Cite
Dombrovsky, Y., M. Ivanova, and D. Ivanov. “Drug Treatment of Phosphate-Calcium Metabolism Disorders in Patients With Chronic Kidney Disease and Mineral and Bone Disorder”. KIDNEYS, vol. 6, no. 3, Jan. 2018, pp. 160-4, doi:10.22141/2307-1257.6.3.2017.109032.
To Help the Practitioner


KDIGO 2017 Clinical Practice Guideline. Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease – Mineral and Bone Disorder (CKD-MBD). Kidney International Supplements. 2017;7(1):1-59. doi: 10.1016/j.kisu.2017.04.001.

Ene-Iordache B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. The Lancet Global Health. 2016;4(5):e307-e319. doi: 10.1016/S2214-109X(16)00071-1.

Tentori F, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2008;52(3):519-30. doi: 10.1053/j.ajkd.2008.03.020.

Merhi B, et al. Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort. American Journal of Kidney Diseases. 2017 Sep;70(3):377-85. doi: 10.1053/j.ajkd.2017.04.014.

Gupta D, et al. Phosphate metabolism in cardiorenal metabolic disease. Cardiorenal medicine. 2011;1(4):261-70. doi: 10.1159/000332388.

Cui L, et al. End stage renal disease induced hypercalcemia may promote aortic valve calcification via Annexin VI enrichment of valve interstitial cell derived‐matrix vesicles. Journal of Cellular Physiology. 2017 Nov;232(11):2985-95. doi: 10.1002/jcp.25935.

Etta PK, et al. Study of chronic kidney disease-mineral bone disorders in newly detected advanced renal failure patients: A Hospital-based cross-sectional study. Saudi Journal of Kidney Diseases and Transplantation. 2017;28(4):874-85. PMID: 28748891.

Lopes AA, et al. Phosphate binder use and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS): evaluation of possible confounding by nutritional status. American Journal of Kidney Diseases. 2012;60(1):90-101. doi: 10.1053/j.ajkd.2011.12.025.

Fernández-Martín JL, et al. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrology Dialysis Transplantation. 2015;30(9):1542-51. doi: 10.1093/ndt/gfv099.

Molony DA, Stephens BW. Derangements in phosphate metabolism in chronic kidney diseases/end stage renal disease: therapeutic considerations. Advances in chronic kidney disease. 2011;18(2):120-31. doi: 10.1053/j.ackd.2011.02.004. PMID: 21406297.

Bouajila IA, Martin PY, DeSeigneux S. Phosphate binders: What are the recent evidences? Revue medicale suisse. 2017;13(551):468-72. (In French). PMID: 28714648.

Shitomi Y, et al. Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate. Pathology International. 2017 Aug;67(8):389-97. doi: 10.1111/pin.12558. PMID: 28660726.

Spasovski G. Advances in pharmacotherapy for hyperphosphatemia in renal disease. Expert opinion on pharmacotherapy. 2015;16(17):2589-99. doi: 10.1517/14656566.2015.1092521. PMID: 26374200.

Patel L, Bernard LM, Elder GJ. Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials. Clinical Journal of the American Society of Nephrology. 2016 Feb 5;11(2):232-44. doi: 10.2215/CJN.06800615. PMID: 26668024.

Komaba H, et al. Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders. Clinical Journal of theAmerican Society of Nephrology. 2017. – С. CJN. 13091216. doi: 10.2215/CJN.13091216. PMID: 28724618.

Cho JH, et al. A Real-world Cost-effectiveness Analysis of Sevelamer Versus Calcium Acetate in Korean Dialysis Patients. Clinical Therapeutics. 2017 Mar 10. pii: S0149-2918(17)30120-0. doi: 10.1016/j.clinthera.2017.02.005. PMID: 28291581.

Sekercioglu N, et al. Effects of different phosphate lowering strategies in patients with CKD on laboratory outcomes: A systematic review and NMA. 2017;12(3):e0171028. doi: 10.1371/journal.pone.0171028. PMID: 28248961.

Misiorowski W, Zgliczyński W. Cinacalcetas symptomatic treatment of hypercalcaemia in primary hyperparathyroidism prior to surgery. Endokrynologia Polska. 2017;68(3):306-10. doi: 10.5603/EP.2017.0023. PMID: 28660989.

Niel O, et al. Cinacalcet in hyperparathyroidism management after pediatric renal transplantation. CEN case reports. 2016;5(2):141-3. doi: 10.1007/s13730-015-0211-0. PMID: 28508965.

Friedl C, et al. Mortality in dialysis patients with cinacalcet use: A large observational registry study. European Journal of Internal Medicine. 2017 Jul;42:89-95. doi: 10.1016/j.ejim.2017.05.002. PMID: 28499709.

Mizuiri S, et al. The coronary artery calcification score and common iliac artery calcification score in non‐dialysis CKD patients. Nephrology. 2017 Jul 3. doi: 10.1111/nep.13113. PMID: 28703899.

Ivanov DD. Next Step in Chronic Kidney Disease Therapy. KIDNEYS. 2016;2.16:10-3. doi: 10.22141/2307-1257.2.16.2016.72205.

Sonkar SK, et al. Vitamin D levels and other biochemical parameters of mineral bone disorders and their association with diastolic dysfunction and left ventricular mass in young nondiabetic adult patients with chronic kidney disease. Saudi Journal of Kidney Diseases and Transplantation. 2017;28(4):758-63. PMID: 28748877.

Peter WLS, et al. A Review of Phosphate Binders in Chronic Kidney Disease: Incremental Progressor Just Higher Costs? Drugs. 2017 Jul;77(11):1155-86. doi: 10.1007/s40265-017-0758-5. PMID: 28584909.

Elder GJ, Center J. The role of calcium and non calcium-based phosphate binders in chronic kidney disease. Nephrology. 2017;22(S2):42-6. doi: 10.1111/nep.13031. PMID: 28429551