Phosphate binders, vitamin D analogues and calcimimetics in CKD

At a glance

• CKD mineral and bone disorder is a systemic disorder of phosphate, calcium, vitamin D, PTH and FGF23 with bone disease and vascular calcification. The drugs act at different steps of one cascade.
• Phosphate binders reduce gut absorption of dietary phosphate. Calcium-based binders add a calcium load; sevelamer, lanthanum and iron-based binders don't.
• Active vitamin D (calcitriol, paricalcitol) replaces lost renal 1-alpha-hydroxylation and suppresses PTH, at the cost of more calcium and phosphate absorption.