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. 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, an