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Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?

BACKGROUND: Aluminium-containing phosphate binders have long been used for treatment of hyperphosphatemia in dialysis patients. Their safety became controversial in the early 1980's after reports of aluminium related neurological and bone disease began to appear. Available historical evidence h...

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Autores principales: Mudge, David W, Johnson, David W, Hawley, Carmel M, Campbell, Scott B, Isbel, Nicole M, van Eps, Carolyn L, Petrie, James JB
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107169/
https://www.ncbi.nlm.nih.gov/pubmed/21569446
http://dx.doi.org/10.1186/1471-2369-12-20
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author Mudge, David W
Johnson, David W
Hawley, Carmel M
Campbell, Scott B
Isbel, Nicole M
van Eps, Carolyn L
Petrie, James JB
author_facet Mudge, David W
Johnson, David W
Hawley, Carmel M
Campbell, Scott B
Isbel, Nicole M
van Eps, Carolyn L
Petrie, James JB
author_sort Mudge, David W
collection PubMed
description BACKGROUND: Aluminium-containing phosphate binders have long been used for treatment of hyperphosphatemia in dialysis patients. Their safety became controversial in the early 1980's after reports of aluminium related neurological and bone disease began to appear. Available historical evidence however, suggests that neurological toxicity may have primarily been caused by excessive exposure to aluminium in dialysis fluid, rather than aluminium-containing oral phosphate binders. Limited evidence suggests that aluminium bone disease may also be on the decline in the era of aluminium removal from dialysis fluid, even with continued use of aluminium binders. DISCUSSION: The K/DOQI and KDIGO guidelines both suggest avoiding aluminium-containing binders. These guidelines will tend to promote the use of the newer, more expensive binders (lanthanum, sevelamer), which have limited evidence for benefit and, like aluminium, limited long-term safety data. Treating hyperphosphatemia in dialysis patients continues to represent a major challenge, and there is a large body of evidence linking serum phosphate concentrations with mortality. Most nephrologists agree that phosphate binders have the potential to meaningfully reduce mortality in dialysis patients. Aluminium is one of the cheapest, most effective and well tolerated of the class, however there are no prospective or randomised trials examining the efficacy and safety of aluminium as a binder. Aluminium continues to be used as a binder in Australia as well as some other countries, despite concern about the potential for toxicity. There are some data from selected case series that aluminium bone disease may be declining in the era of reduced aluminium content in dialysis fluid, due to rigorous water testing. SUMMARY: This paper seeks to revisit the contemporary evidence for the safety record of aluminium-containing binders in dialysis patients. It puts their use into the context of the newer, more expensive binders and increasing concerns about the risks of calcium binders, which continue to be widely used. The paper seeks to answer whether the continued use of aluminium is justifiable in the absence of prospective data establishing its safety, and we call for prospective trials to be conducted comparing the available binders both in terms of efficacy and safety.
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spelling pubmed-31071692011-06-03 Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice? Mudge, David W Johnson, David W Hawley, Carmel M Campbell, Scott B Isbel, Nicole M van Eps, Carolyn L Petrie, James JB BMC Nephrol Debate BACKGROUND: Aluminium-containing phosphate binders have long been used for treatment of hyperphosphatemia in dialysis patients. Their safety became controversial in the early 1980's after reports of aluminium related neurological and bone disease began to appear. Available historical evidence however, suggests that neurological toxicity may have primarily been caused by excessive exposure to aluminium in dialysis fluid, rather than aluminium-containing oral phosphate binders. Limited evidence suggests that aluminium bone disease may also be on the decline in the era of aluminium removal from dialysis fluid, even with continued use of aluminium binders. DISCUSSION: The K/DOQI and KDIGO guidelines both suggest avoiding aluminium-containing binders. These guidelines will tend to promote the use of the newer, more expensive binders (lanthanum, sevelamer), which have limited evidence for benefit and, like aluminium, limited long-term safety data. Treating hyperphosphatemia in dialysis patients continues to represent a major challenge, and there is a large body of evidence linking serum phosphate concentrations with mortality. Most nephrologists agree that phosphate binders have the potential to meaningfully reduce mortality in dialysis patients. Aluminium is one of the cheapest, most effective and well tolerated of the class, however there are no prospective or randomised trials examining the efficacy and safety of aluminium as a binder. Aluminium continues to be used as a binder in Australia as well as some other countries, despite concern about the potential for toxicity. There are some data from selected case series that aluminium bone disease may be declining in the era of reduced aluminium content in dialysis fluid, due to rigorous water testing. SUMMARY: This paper seeks to revisit the contemporary evidence for the safety record of aluminium-containing binders in dialysis patients. It puts their use into the context of the newer, more expensive binders and increasing concerns about the risks of calcium binders, which continue to be widely used. The paper seeks to answer whether the continued use of aluminium is justifiable in the absence of prospective data establishing its safety, and we call for prospective trials to be conducted comparing the available binders both in terms of efficacy and safety. BioMed Central 2011-05-13 /pmc/articles/PMC3107169/ /pubmed/21569446 http://dx.doi.org/10.1186/1471-2369-12-20 Text en Copyright ©2011 Mudge et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Debate
Mudge, David W
Johnson, David W
Hawley, Carmel M
Campbell, Scott B
Isbel, Nicole M
van Eps, Carolyn L
Petrie, James JB
Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title_full Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title_fullStr Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title_full_unstemmed Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title_short Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
title_sort do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
topic Debate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107169/
https://www.ncbi.nlm.nih.gov/pubmed/21569446
http://dx.doi.org/10.1186/1471-2369-12-20
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