Renagel is a novel, nonabsorbed, phosphate binding polymer free of aluminum and calcium. In hemodialysis patients, Renagel: lowers serum phosphorus levels; lowers intact parathyroid hormone levels; lowers calcium x phosphorous levels; lowers total serum and low density lipoprotein (LDL) cholesterol; and is safe and well tolerated (Bleyer et al., 1997; Chertow, Burke, Dillon, et al., 1998; Chertow, Burke, Goldberg, et al., 1997; Chertow, Burke, Lazarus, et al., 1997; Goldberg et al., 1998; Slatopolsky, Burke, Dillon, & The Renagel Study Group, 1999). Renagel treatment decreased total and low-density lipoprotein (LDL) cholesterol, but had no effect on high-density lipoprotein (HDL) cholesterol and triglycerides (Goldberg et al., 1998; Slatopolsky et al., 1999). This cholesterol-lowering effect of Renagel was most apparent in patients with LDL cholesterol of 100 mg/dl or greater at baseline; therefore, it may be beneficial for some patients. Longer-term studies in ESRD patients are required to determine the potential benefit of lipid lowering (Slatopolsky et al., 1999). The nephrology staff is responsible for delivering optimal patient care. This new drug allows for adequate control of phosphorous without incidence of hypercalcemia, or aluminum related problems.