Recommendation ID
Sequencing and combining of phosphate binders in adults:- For adults with stage 4 or 5 chronic kidney disease (CKD), including those on dialysis, what is the most effective sequence or combination of phosphate binders to control serum phosphate?
Any explanatory notes
(if applicable)
Why this is important:- It is thought that the longer people remain on calcium-based binders, the greater their risk of developing hypercalcaemia. However, no evidence was found on the most appropriate sequence or combination of phosphate binders a person should receive to control serum phosphate and serum calcium. A series of RCTs should be conducted separately in adults with stages 4 or 5 chronic kidney disease (CKD) who are not on dialysis and those with stage 5 who are on dialysis. These trials should be run for a minimum of 12 months and should examine comparative effectiveness of various sequences and combinations of available phosphate binders on outcomes such as serum phosphate, serum calcium, adverse events and the ability of the binders to control serum phosphate and calcium within the given ranges.

Source guidance details

Comes from guidance
Chronic kidney disease (stage 4 or 5): management of hyperphosphataemia
Date issued
March 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 27/03/2013