Why some dialysis patients no need take the Binder?

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Why some dialysis patients no need take the Binder ?

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Phosphate binders are prescribed when patients have high phosphorus to protect their bones. If patients are able to limit the amount of phosphorus in foods they eat or they do enough hours of dialysis, the phosphorus level in their blood may stay in the target range. However, most patients have to take binders when they eat to keep their phosphorus in range.

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Thanks Beth!
I didn’t know the impact of Phosphorus on bones. May be my wife’s current test results of Alkaline Phosphatase has something to do with bone although her phosphorus became normal after 2 weeks of staying high (we did give her good binder (Renvela 800 mg component is sevelaner carbonate in tablet form ) twice a day after a meal.

And,yes as the question asked about why some patients don’t need any binder at all. My wife also didn’t need to have it almost fot 6-7 months(excluding first 2 months of dialysis and last 2 weeks of dialysis,out of total 10 months ) when her phosphorus was always in normal range .

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Hi Faconnerd,
I’d be sure to ask your wife’s dietitian how Renvela should be taken. It’s my understanding (and the full prescribing information says this) is to take it WITH means. In my old clinic where I worked as a social worker, the dietitian told patients to take their phosphate binder during meals rather than before or after meals. Here’s what the FDA approved prescribing information says:

" 17 PATIENT COUNSELING INFORMATION
Inform patients to take Renvela with meals and adhere to their prescribed diets.
For patients using an oral medication where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, advise the patient to take the oral medication at least one hour before or three hours after Renvela.
For Renvela powder, brief the patient on preparation of the powder in water.
Advise patients to report new onset or worsening of existing constipation or bloody stools promptly to their physician [see Warnings and Precautions (5.1)].

Your wife’s dietitian is the expert so far as advising patients how to take phosphate binders and the foods to limit due to their high phosphorus content.

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Yes, you got it right. It’s actually WITH the meal which I have given to my wife.
Doctors - one of the Nephrologist said with the meal and current one said after the meal so I had to look for the drug proposed direction of use myself for it.

Sorry for quoting it ‘after the meal’ earlier.

And,yes - we did limit her phosphorus food intake between 2 dialysis sessions.

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It’s important to know the phosphorus content in foods and unfortunately that’s not listed on food labels. Here’s a nutrition counter that lists sodium, potassium, phosphorus and more in many foods. If she can stick with what’s in her diet prescription, she should be able to keep her bones and blood vessels healthy. https://aakp.org/wp-content/uploads/2021/03/NutritionCounter_English_030321_Digital-2.pdf

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Thanks!
I missed to see your reply. Got occupied here n there in other issues.

Yes , there are few thumb rules I tried to follow - things in moderation to keep phosphorus under check.

I will surely have a look at the the given url.

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Another thing that can help control phosphorus is longer dialysis. Hemodialysis patients who do overnight (longer) HD may not need to take binders to control their phosphorus and actually may be able to eat more phosphorus in their diet or need to supplement phosphorus with medication.

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Yes, longer dialysis was one of the option i tried couple of times but could not go beyond 5 hrs in center HD arrangement.
May be for couple of weeks frequent dialysis could help (thrice in a week than twice in a week) .

Also , I was thinking if reverting her dialyser from F6 to Fx8 can help because f6 is low flux dialyser and Fx8 is high flux .

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I am a social worker, not a nurse or doctor so I looked for a study. This study published in 2016 found that a high flux dialyzer removed more phosphorus than a low flux one or online hemodiafiltration. ASAIO Journal

Longer dialysis is not easy to do in a clinic where there are multiple patients being treated. It is very possible when a patient is doing home hemodialysis.

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Thanks Beth for sharing the journal.
I was looking for stats/research on comparative analysis . It does help to distinguish use of dialysis mahine and specific dialyser. High flux and HDF machine win over.

Sorry for replying late . I was occupied attending wife in hospital admission for her treatment of sepsis.

Fortunately, I was able to feed her regular phosphorus binders with fail in twice a day dose with meal and once in 4 session use of Fx8(High flux dialyser).
That approach has helped to contain serus phosphorus levels within the desired range although during her hospitalization we got to know calcification in her blood vessels in abdominal aorta region which could be due to weak metabolism of calcium and phosphorus. Hope that won’t hinder her AV graft fistula surgery.

So far her serum calcium and serum phosphorus is within the range so once in few weeks rotating over high flux dialyser and low flux dialyser in 1:4 ration may serve the purpose.

Fingers crossed.