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. and Petrie, James J. B. (2011) Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?. BMC Nephrology, 12 1: 20.1-20.8. doi:10.1186/1471-2369-12-20

Author Mudge, David W.
Johnson, David W.
Hawley, Carmel M.
Campbell, Scott B.
Isbel, Nicole M.
van Eps, Carolyn L.
Petrie, James J. B.
Title Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?
Journal name BMC Nephrology   Check publisher's open access policy
ISSN 1471-2369
Publication date 2011-01-01
Sub-type Article (original research)
DOI 10.1186/1471-2369-12-20
Open Access Status DOI
Volume 12
Issue 1
Start page 20.1
End page 20.8
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article # 20

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 23 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 25 Aug 2011, 20:39:15 EST by Dr David Mudge on behalf of Medicine - Princess Alexandra Hospital