Phosphate binders: Bind it in the gut
Janie R. Robinson PhD, RN

Nursing Made Incredibly Easy!
June 2014 
Volume 12  Number 3
Pages 50 - 52
  PDF Version Available!

Many hospital nurses are faced with the challenge of taking care of patients with end-stage renal disease (ESRD). Because these patients' kidneys are no longer functioning, they require renal replacement therapy or a kidney transplant to sustain life.The kidneys control phosphorus-an essential electrolyte needed for homeostasis. Phosphorus and calcium have an inverse relationship. Normally, when phosphorus levels are elevated, calcium levels are decreased. However, when the kidneys don't function, phosphorus can't be excreted, leading to elevated phosphorus levels. The calcium level is decreased because of the lack of vitamin D activation by the failed kidney. As a result, calcium absorption is decreased, leading to low calcium levels.The main source of phosphorus intake is through the diet, including dairy products, nuts, seeds, and beans. Many high-phosphorus foods are difficult to avoid because phosphorus is used in a variety of processed foods. Generally, 60% to 70% of phosphorus absorption takes place in the gastrointestinal (GI) tract. An elevated phosphorus level is referred to as hyperphosphatemia. Normal phosphate levels are 3.0 to 4.5 mg/dL; in ESRD, target phosphorus levels are 3.5 to 5.5 mg/dL.In order to decrease the risk of complications associated with hyperphosphatemia, phosphorus levels are managed using phosphate binders. Let's take a closer look.Phosphate binders work by binding to phosphorus in the GI tract (small intestine). After the phosphorus binds, it can't be absorbed into the bloodstream. It's important to know why your patient is taking this class of drug. Many phosphate binders serve other purposes. Some may be used as an antacid or as an electrolyte supplement (see Types of phosphate binders).There are four types of phosphate binders: aluminum-based, calcium-based, noncalcium-based, and nonaluminum-based: * Aluminum-based phosphate binders aren't recommended to be used in ESRD because they leave aluminum deposits in the body, causing toxicity

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