EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep TangriNon calcium phosphate binders - Is there any evidence of benefitJadav, Paresh R.a; Husain, S. Alia,b; Mohan, Sumita,b,c; Crew, Russella Author Information aDepartment of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY bThe Columbia University Renal Epidemiology (CURE) Group cDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA Correspondence to Paresh R. Jadav, MD, FASN, Division of Nephrology, Columbia University Medical Center, 622W 168th St, PH4-124, New York, NY 10032, USA. E-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-nephrolhypertens.com). Current Opinion in Nephrology and Hypertension: May 2022 - Volume 31 - Issue 3 - p 288-296 doi: 10.1097/MNH.0000000000000796 Buy SDC Metrics Abstract Purpose of review Low-level evidence and opinion-based clinical practice guidelines highlight the substantial uncertainty in the practice patterns of hyperphosphatemia management in patients with chronic kidney disease (CKD). This manuscript reviews the evidence for the choice of phosphate binders and its impact on clinical outcomes. Recent findings Phosphate binders are among the most common medications prescribed for patients on dialysis. Clinical practice guidelines recommend lowering phosphate levels toward normal range and restricting calcium-based binders in all CKD patients. There is substantial gap in the evidence underlying these recommendations with lack of any placebo-controlled, randomized trials showing survival benefits for any class of phosphate-binders. Despite the lack of evidence for specific phosphate target or if lowering phosphate improves survival, use of phosphate binders has remained central strategy in approach to hyperphosphatemia. Use of binders has added to the cost and contributed significant pill burden. Restriction of calcium-based binders to avoid positive calcium balance and consequent vascular calcification risk has a physiological rationale and weight of observational studies. Summary There is currently no conclusive evidence that definitively guides the choice of any specific binders for management of hyperphosphatemia in patients with CKD. Use of noncalcium-based binders has a theoretical advantage in restricting total calcium intake to decrease the risk of vascular calcification but no proven benefits for mortality. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.