‘Phos’ing over phosphorus: A primer on updates in phosphate binders

1.) Patients should have phosphorous targeted to appropriate levels based on degree of renal impairment for the following reasons:

2.) 63-year-old female (dialysis vintage 3 years) with normocalcemia; hyperphosphatemia. Renal dietician has assessed and would prefer not to restrict diet d/t limited intake. Currently on lanthanum 500 mg tid. Patient unable to increase d/t constipation at higher doses. PMHx does not reveal any significant GI disorders. Patient pays for meds out-of-pocket. Most appropriate course of action for treating CKD-MBD includes:

3.) 55-year-old male (dialysis vintage 1 year) with Hx failed renal transplant 10 yrs ago on mycophenolate mofetil 500 mg bid. Mildly low calcium; hyperphosphatemia. Other blood work of note includes Hgb 94. TSAT 15%. Ferritin 250. Patient has private drug coverage. BEST option for treatment:

4,) 70-year-old female (dialysis vintage 3 years) on pantoprazole 40 mg bid (Zollinger-Ellison syndrome) with hypercalcemia; hyperphosphatemia. Also has PMHx bowel perforation. BEST option for treatment:

5.) 85-year-old male (dialysis vintage 10 years) with hyperphosphatemia; normocalcemia. Patient is unable to swallow tablets whole. Relevant PMHx includes calciphylaxis (approx. 14 mos ago; now in remission) and chronic constipation.

6.) In comparing sucroferric oxyhydroxide to sevelamer hydrochloride (Renagel™) in clinical trials, Velphoro™:

7.) Which phosphate binder(s) are indicated in treatment of hyperphosphatemia in pre-dialysis patients?

8.) Appropriate counselling point(s) for Velphoro™ include:

9.) Which of the following statements is TRUE:

10.) 49-year-old male (dialysis vintage 8 years) with hyperphosphatemia requiring treatment. Patient also has GI disease, metabolic acidosis, and hypercalcemia. Most appropriate treatment option: