Accumulation of metals and minerals from phosphate binders

Blood Purif. 2005:23 Suppl 1:2-11. doi: 10.1159/000083712.


Metals and minerals that depend on renal clearance may accumulate to toxic levels in patients with marginal kidney function. Toxicities of aluminum-based phosphate binders became apparent approximately 25 years ago. Nephrologists now recognize cardiovascular calcification may follow use of calcium-based phosphate binders. Five lessons can be learned: (1)safety must not be assumed in absence of data; (2) all evidence for causal linkage of toxicities from therapeutics must be considered, including animal data; (3) clinical trials are unlikely to reveal the spectrum of problems from long-term drug exposure; (4) complications can remain unrecognized until late in post-introduction surveillance; (5) minerals important for normal function can be toxic with excess accumulation. Introduction of new agents necessitates caution - it is difficult to change practice once a therapeutic is commonplace. Lessons learned about hazards of past phosphate binders must be applied judiciously when evaluating long-term risks/safety of novel metal-based binders such as lanthanum carbonate.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aluminum / therapeutic use
  • Aluminum / toxicity
  • Calcium / therapeutic use
  • Calcium / toxicity
  • Humans
  • Kidney Failure, Chronic / drug therapy*
  • Lanthanum / therapeutic use
  • Lanthanum / toxicity
  • Metals / therapeutic use*
  • Metals / toxicity
  • Minerals / therapeutic use*
  • Minerals / toxicity
  • Phosphates / metabolism*


  • Metals
  • Minerals
  • Phosphates
  • Lanthanum
  • Aluminum
  • Calcium