Beyond their phosphate binding ability, phosphate binders may affect gastrointestinal (GI) function, nutrient and molecule binding, and the gut microbiome, according to Sharon M. Moe, MD, of Indiana University and colleagues in a new evidence review published in the Journal of Renal Nutrition.

Sevelamer, one of most studied medications, may bind to bile acids, endotoxins, gut microbiota-derived metabolites, and advanced glycation end products, they noted. The binder appears to reduce endotoxemia as well as inflammation and may help improve metabolic profile.

Both calcium- and noncalcium-based binders may bind vitamins, such as vitamin K and folic acid. Iron-based phosphate binders may alter the gut microbiota when iron or organic ligands are used by gastrointestinal bacteria.

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To the extent that these alterations lead to systemic effects, they may directly affect patient outcomes such as inflammation, vascular calcifications, and improve the metabolic profile, Dr Moe and the team stated. They encourage future exploration of the composition of the gut microbiome in chronic kidney disease patients and its possible relationship with outcomes.


Biruete A, Hill Gallant KM, Lindemann SR, Wiese GN, Chen NX, Moe, SM. Phosphate binders and nonphosphate effects in the gastrointestinal tract. J Ren Nutr. DOI:10.1053/j.jrn.2019.01.004