1. ¹Inserm Unit 507, Necker Hospital, University of Paris V, Paris, France
2. ²Inserm ERI-12, University of Picardie and Amiens University Hospital, Amiens, France
3. ³Laboratory of Biochemistry A, Necker Hospital, University of Paris V, Paris, France

Correspondence: ZA Massy, INSERM ERI-12, Division(s) of Clinical Pharmacology and Nephrology, Amiens University Hospital, Av. René Laennec, F-80054 Amiens, France. E-mail: massy@u-picardie.fr

Abstract

The number of chronic kidney disease (CKD) patients and related adverse outcomes has dramatically increased worldwide in the past decade. Therefore, numerous experimental and clinical studies have recently addressed the underlying mechanisms, in particular the marked increase in cardiovascular mortality. Hyperphosphatemia is a major problem in these patients with advanced stage of CKD. Its control by calcium-containing phosphate binders is effective, but at the price of potentially noxious calcium overload. Sevelamer hydrochloride is a phosphate binder that offers an effective control of hyperphosphatemia as calcium-rich binders but without increase of calcium load. Beyond the control of phosphate, sevelamer seems to exert pleiotropic effects which include the correction of lipid abnormalities and the clearance of some uremic toxins.