Phosphate binders are suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines to treat hyperphosphatemia in patients with stage 3–5 nondialysis CKD . A promising option is sucroferric oxyhydroxide (Velphoro(®), PA21), an iron-based phosphate binder consisting of a mixture of polynuclear iron(III) … Factors that should be taken into consideration when selecting a specific drug include CKD stage, cardiovascular disease, severity of secondary hyperparathyroidism, concomitant medications, life expectancy and patient compliance. Hyperphosphatemia in patients with chronic kidney disease leads to secondary hyperparathyroidism and renal osteodystrophy, and it is independently associated with mortality risk. Kidney International, Vol. Common phosphate binders: Caltrate 600mg calcium carbonate Swallow Calsup 500mg calcium carbonate … Phosphate binders: calcium acetate, lanthanum, sevelamer (all Class IIb, Level of Evidence C) 3. 5.1 If phosphorus or intact PTH levels cannot be controlled within the target range (see Guidelines 1, 3), despite dietary phosphorus restriction (See Guideline 4), phosphate … The number of dialysis patients who were dispensed at least 1 Part D–covered phosphate binder increased from 204,208 in 2008 to 263,404 in 2013 (a 29% increase), while corresponding percentages of phosphate binder users were stable at ∼76% ().Use of specific phosphate binders shifted over time. Phosphate binder me dication helps to lower your blood phosphate levels by binding to the phosphate in your food so less is absorbed into the bloodstream. 6.3a In patients taking calcium-based phosphate binders, the dose should be reduced or therapy switched to a noncalcium-, nonaluminum-, nonmagnesium-containing phosphate binder. They should always be used in conjunction with dietary phosphate restriction, to control serum phosphorus levels. phosphate binders compared to non-calcium based phosphate binders). During the study period, the usual care regarding edu-cation and counselling specific to phosphate and phos-phate binder treatment was continued in the dialysis unit. Recent advancements have been made in phosphate-binder treatment. S7–S14 Phosphate binder therapy for attainment of K/DOQITM bone metabolism guidelines CHARLES R. NOLAN University of Texas Health Sciences Center at San Antonio, San Antonio, Texas We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels. This article reviews the current knowledge regarding safety, effectiveness, and adherence with currently marketed phosphate binders and those in development. In an analysis of Medicare … Such a request for prior authorization will be (OPINION) See Guideline 5. In patients with CKD stages 3–5 (2D) and 5D (2B), we suggest using phosphate-binding agents in the treatment of hyperphosphatemia. Phosphate lowering requires a multi-professional approach to therapy. Phosphate binders should be taken with meals for maximal efficacy. The biggest challenge to phosphate binder efficacy is non-adherence. phosphate binder: effect, importance, practical informa-tion regarding intake, possible side effects and interactions with other medicines. OR 2. If the guidelines are not met, the prior authorization request will be referred to a physician reviewer for a medical necessity determination. Accordingly, new phosphate binders are under investigation and some of them have already been approved. Patients can be instructed to tailor phosphate binder intake to the phosphate content and frequency of meals. Calcium-based phosphate binders are generally used as the initial binder therapy for patients with chronic kidney disease as they are cheap and relatively efficacious, in conjunction with dietary phosphate restriction, to control phosphorus and parathyroid levels. Hold tube feedings for a period both before and after medication administration: 3.1. penicillin V, phenytoin (one alternative) , theophylline (all Class IIa, Level of Evidence B) 3.2. If the guidelines in Section B. are met, the reviewer will prior authorize the prescription. Phosphate binders are used to reduce positive phosphate balance and to lower serum phosphate levels for people with chronic kidney disease (CKD) with the aim to prevent progression of chronic kidney disease-mineral and bone disorder (CKD-MBD). Interactive Tools Plan a Lobby Day! Controlling Phosphorus Through Binder Adherence These resources have been gathered to help the dialysis caregiver help their patients understand the importance of adherence to the binder prescription, as well as choosing foods that are low in phosphorus.