All About Binders

By Kim Holdener, Pharm D

One of the common problems that people with kidney disease have is managing phosphorus levels.

Phosphorus is removed from the body by the kidneys. When kidney function starts to decline, most people develop high phosphorus levels. High phosphorus levels can cause problems with your bones and lead to bone disease. With bone disease, your bones are not strong and fractures may be more common.

High amounts of phosphorus can also bind with calcium in your body, build up in your blood vessels and cause heart disease. Heart disease is the most common cause of death in dialysis patients Phosphorus can also bind with calcium and build up in the skin causing skin lesions that are very hard to heal. Other symptoms that some people have when phosphorus levels are too high are itching and bone pain.

Many of the foods we commonly eat contain phosphorus: diary products like milk, cheese, yogurt, ice cream, nuts, dark sodas like Coke and Pepsi, red meat, chocolate, and many more. (You can ask the dieticians for a more complete list.) This makes it hard to control phosphorus levels and is one of the reasons it is important to follow the special diet for dialysis patients. The only way to lower phosphorus levels (besides controlling the amount in your diet) is to take a phosphorus binder. Phosphorus binders are medications that are taken when you eat that prevent your body from absorbing the phosphorus in the food.

There are two commonly used types of phosphorus binders – binders that contain calcium and binders that do not. Calcium containing binders include calcium carbonate (such as Tums, Caltrate, OsCal, etc.) and calcium acetate (PhosLo). Non-calcium binders are sevelamer (Renagel or Revela) and lanthanum (Fosrenol). Your healthcare team at WDI will recommend the binder that is the best choice for you.

There are many circumstances that will affect which binder is best for you to take. Calcium carbonate binders are the least expensive and can be bought over-the-counter without a prescription. For this reason, calcium carbonate binders are often recommended for people without prescription insurance. However, they are often not as effective as other binders.

Calcium acetate (PhosLo) is the other calcium binder. IT is a very effective binder and requires a prescription. It is a common first choice binder for people who have prescription insurance. However, if your calcium levels become too high then you can not take binders that contain calcium. High calcium levels can be dangerous.

Binders that do not contain calcium (sevelamer and lanthanum) are also common first choice binders that are recommended. You may need to take more tablets of these non-calcium binders to get the same effect as calcium acetate. For people with high calcium levels, sevelamer and lanthanum are the best binders to use. Often it takes a combination of different types of binders to control phosphorus levels.

Phosphorus levels can be difficult to control. It usually takes a combination of diet control and phosphorus binder mediations to keep phosphorus at a safe level. To get the best effects from your binders you need to take them with every meal. The dieticians work closely with you to make sure you know what foods to avoid, how to take your binders, and which binder and dose is the best for you. Every patient is different and your health care team will assess and recommend what they think is the best regimen for you.

Top 5 phosphorus foods to reduce or avoid

  1. Cola
  2. Milk products (cheese, ice cream and yogurt)
  3. Nuts and seeds
  4. Dried beans and dried peas
  5. Bran cereal