, Volume 40, Issue 4, pp 1009-1014
Date: 04 Oct 2008

Calcium and the saga of the binders: accumulating controversy, or building consensus?

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At the heart of the oral phosphate binder debate is whether, with the abandonment of aluminium as the main phosphate binder for dialysis patients and its substitution by calcium salts from the early 1980s, we have unleashed a “weapon of mass calcification” by engendering a positive “calcium balance” favouring extensive/progressive soft tissue calcification. More recently we have realized that the near endemic presence of calcium in the walls of blood vessels of chronic kidney disease patients cannot be viewed with either equanimity or passivity. The process of calcium deposition, in a crystalline structural form, is actively regulated. As such, of course, it has active promoters and inhibitors. Active players in the debate about this controversy include the manufacturers of non-calcium-containing phosphate binders, for whom making a convincing scientific and pharmaco-economic case for a potentially expensive change in prescribing practice has a high priority [1].