Mineral and bone disorders in
chronic kidney disease (CKD) patients along with the use of
calcium-based
phosphate binders may result in
vascular calcification (VC) development and associated increase in
cardiovascular diseases (CVD) mortality. A few treatment modalities to control
hyperphosphatemia, VC and CVD over the years have failed. Recently appeared
calcium-
aluminum free
phosphate binders (
sevelamer hydrochloride and
lanthanum carbonate) have reduced hypercalcemic adverse events compared to
calcium-based binders, although beneficial effects on CVD outcome to justify further widespread utilization of these agents in CKD patients are not reported so far. At present long-term safety of
lanthanum administration has been challenged based on its similarities with
aluminum and associated liver toxicity reported in experimental rat models. However, recent evidence in CKD patients and the absence of solid arguments for any particular rat organ toxicity, suggest that
lanthanum is safe and efficient in treatment of
hyperphosphatemia. Classical interventions aimed to reduce PTH concentration are associated with an increase in Ca x P product. A major breakthrough here was achieved with introduction of calcimimetics (
cinacalcet). Apart from its effectiveness in reduction of PTH and Ca x P product, a lot of controversy appeared on the cost-effectiveness of this
drug in absence of CVD outcome evidence. Hence, adoption of these new therapeutical strategies might be reserved for adamantine cases when there is no economical constraint for this long-term treatment. In this regard, new therapeutic strategies and patents in CKD patients will be discussed in this review.