The Dawn of Dialysis Patients: How to Choose Phosphorus Binding Agents In recent years, China’s chronic kidney disease (CKD) dialysis patients are on the rise year by year, and hyperphosphatemia is one of the most important factors affecting their survival. kdigo guideline clearly points out that: the treatment of hyperphosphatemia in CKD can be achieved through dietary phosphorus restriction, intensive dialysis and the use of phosphorus binding agents to control blood phosphorus levels. old Liu has been suffering from CKD dialysis for many years, and he has been unfamiliar with the use of phosphorus binding agents, from the early Old Liu has been suffering from CKD dialysis for many years, and is no stranger to phosphorus binding agents, from early aluminum hydroxide, calcium carbonate, calcium acetate, to the newer phosphorus binding agents nowadays, such as lanthanum carbonate, sevelamer, and so on. Aluminum, as an early phosphorus-binding agent, has been replaced by calcium-containing phosphorus-binding agents since the 1990s, when it was recognized that it could cause adverse reactions such as anemia, neurotoxicity and bone mineralization damage. Calcium carbonate and calcium acetate are the most commonly used calcium-phosphorus binding agents, which can combine with ingested phosphorus in the intestine to form calcium phosphate, inhibit phosphorus absorption, and have good phosphorus-lowering effects. However, because calcium salts can often be partially absorbed and easily lead to an increase in calcium load, causing hypercalcemia, which can cause low-running bone disease and increase the risk of vascular calcification, vascular calcification in patients with CKD, it is possible to have a widening of the pulse pressure, a decrease in diastolic blood pressure, systolic blood pressure, and ultimately lead to patients with coronary artery perfusion insufficiency, left ventricular hypertrophy, and cardio-cerebral vascular events. Therefore, its application has been somewhat limited. In recent years, the emergence of various new phosphorus binding agents has brought a boon to the treatment of hyperphosphatemia in CKD patients. Sevelamer is the only calcium-free, metal-free phosphorus-binding agent that is not absorbed after oral administration, and almost 100% is excreted in the feces. 2014 Chinese phase III study published in NDT showed that compared with placebo, Sevelamer significantly reduced phosphorus by 0.69 mmol/L (2.14 mg/dL) within 8 weeks. The 2005 RIND study showed an 11-fold increase in coronary artery calcium score (CACS) in the calcium-treated group compared to the sevelamer-treated group after 18 months of treatment, and both the 2007 RIND study and the 2013 INDEPENDENT study found that sevelamer had a better survival benefit in dialysis patients than calcium-phosphorus binding agents. And a 2013 meta-analysis published in the Lancet of more than 4,600 patients in 11 randomized controlled trials showed that CKD patients on non-calcium-phosphorus binding agents (sevelamer, lanthanum carbonate) had a 22% reduction in all-cause mortality and a significant delay in the progression of coronary artery calcification relative to those assigned to the calcium-phosphorus binding agent group. Furthermore, a secondary analysis of the DCOR study evaluated the pharmacoeconomics of sevelamer versus calcium carbonate in dialysis patients with chronic kidney disease. The results showed that patients on sevelamer had an 11% decrease in hospitalization rates and an 11.5% decrease in average hospital days compared to the calcium carbonate group. Another non-aluminum, non-calcium phosphorus-binding agent, lanthanum carbonate, also had a strong ability to remove phosphorus from the patient’s body. Lanthanum carbonate is taken orally, binds to dietary phosphorus to form an insoluble complex, and is excreted through the gastrointestinal tract. A meta-analysis showed that lanthanum carbonate reduced calcium-phosphorus product levels when compared to calcium salts, while its phosphorus-lowering effect was similar to that of calcium salts. Adverse effects of lanthanum carbonate include gastrointestinal reactions such as nausea and vomiting. Some studies suggest that lanthanum can accumulate in the patient’s organs such as the liver, brain and bones. Hemodialysis patients using lanthanum for more than 1 year plasma lanthanum levels and bone lanthanum content increased significantly, even if the drug is discontinued, lanthanum accumulation in the bone is difficult to improve . In conclusion, the new phosphorus binding agent, Svelamer, with no systemic absorption and high safety, can significantly reduce blood phosphorus level, significantly delay vascular calcification in CKD dialysis patients, reduce the risk of all-cause death and cardiovascular death in CKD dialysis patients, and bring a new dawn to CKD dialysis patients. Under the doctor’s advice, Lao Liu adheres to dietary control, strengthens hemodialysis, and chooses appropriate phosphorus binding agent, and now his condition is stable, his blood phosphorus is controlled within the ideal range, and he is full of hope for his life and masters his future.