Phosphate Binders

[angieskidney]

Hello all.  Renagel has worked well for me.  I take 4 800mg tabs with meals. 

Ya, and with the SIZE of those pills .. there is no way for me So I just take one 1000mg Tums and I am all set!

My bloodwork results: My Phosphate was PERFECT this month!!!! 

[BigSky]

I take Renagel myself.  Was on Phoslo but it raised my calcium levels way too high.

The ones that I hated swallowing were the old aluminum binders back in the day.

[kitkatz]

Nummy, yummy for the tummy fosrenol.  Like eating chalk, but I manage to choke it down after every meal if I remember it.  I am going to start puttping one in my lunch box everyday with lunch so I remember at work to take it.

[alaskagirl]

I don't think Tums is a binder.  Don't people take it for the calcium content?

[BigSky]

Some people are able to use TUMS as their binder.   

TUMS is calcium carbonate and PhosLo is calcium acetate. 

Drug companies say TUMS binding action isn't as great as their drugs are.  However it really depends on the patient.  Some can get away with it and some cannot. 

[Bajanne]

For a short time, I used Tums only, and my labs showed some control of my phosphate/calcium situation.  This last month however, I was not so 'compliant' and I got a warning on Friday from my nephro.

[angieskidney]

I don't think Tums is a binder.  Don't people take it for the calcium content?

Yes, Tums can be taken as a phosphate binder as long as you can take the Calcium. I don't take additional calcium and my dietitian and Nephrologist said to take them so I do. I have been told how much and everything. So yes, it is definately used as a phosphate binder. I take 1000mg ones. I take up to 3 with each meal depending on what I am eating and how much.

Here is a link about it and which I quote from:

Tums® (calcium carbonate; Smith-Kline Beecham, Pittsburgh, PA) is primarily used as an antacid,3 but has been used as a source of calcium carbonate to bind phosphorus in hyperphosphatemia patients.

[Zach]

Right now I'm using a combination of one Renagel for every two PhosLo -- instead of taking three PhosLo for meals with larger phosphorus loads.

In the past I've used TUMS EX. And in the old days, I took OSCAL and in the beginning there was Baselgel (Aluminum, very bad for us!).

I struggle with keeping my phosphorus down to about 5.5 mg/dL, while not raising my calcium above 10 mg/dL.  Last week the calcium was 10.8 and phosphorus was 4.9, the week before the calcium was 10.3 and phosphorus was 5.6   

TUMS and PhosLo overtime raised my calcium, so I tried switching to Renagel, but it gave me indigestion and lowered my Carbon Dioxide level (CO₂).  I'm now trying the combination.

I also just switched from IV Hectoral to IV Zemplar (to reduce PTH levels).  PTH medications can affect the gut's absorption of calcium.  We'll see what happens!

[BigSky]

I also just switched from IV Hectoral to IV Zemplar (to reduce PTH levels).  PTH medications can affect the gut's absorption of calcium.  We'll see what happens!

Should see a drop.  My PTH was high so I was put on hectoral and my Calcium stayed the same, 8.5 but my phosphorus dropped from 3.5 down to 2.0.

[Zach]

Hey BigSky,

Those are some impressive numbers you've got!

[MattyBoy100]

hi,

I have to take 3 Renegels before each meal.  I don`t worry about the cost of my drugs cos living in the UK and my illness being considered chronic and because I have a fistula, I get them for free from the National Health Service although this isn`t the case for every type of illness.

[Python]

Ian only has to take three pills.

Folic Acid
Alphacalcidol
Calcichew

Rephrase that, Ian is supposed to take the above three.  Despite reminding, he never does.  Ironically, when he does take them, his bloods go all over the place, when he doesn't take them his bloods are good and he eats pretty much of what he wants although we do tend to have good, balanced meals.

He does, however, take his EPO - under duress.

[waitlisted]

I take calcium carbonate 750 mg twice daily with meals.

[Zach]

Anyone finding that their CO₂ levels are going below normal since taking Renagel?
Carbon Dioxide Normal = 20 - 30 MEQ/L

[Zach]

I keep containers of each in my work truck , in my car, at home, and in my wifes purse ( probobly the most important place!)

That's a really good idea ... you'll have them practically everywhere you go.

[angieskidney]

I keep containers of each in my work truck , in my car, at home, and in my wifes purse ( probobly the most important place!)

That's a really good idea ... you'll have them practically everywhere you go.

Ya I find if I don't keep separate containers everywhere that I might forget my binders

[geoffcamp]

I tried tums hated the taste (like that should matter)!  I am now on the Phoslo gel caps and they seem to be working well.

[angieskidney]

I tried tums hated the taste (like that should matter)!  I am now on the Phoslo gel caps and they seem to be working well.

I've only been offered Renegel. I hate the taste of most Tums (am VERY picky since the chalky taste is bad enough but also effects the taste of the food I am about to eat ...) but I have found I like the minty ones for dinners and the berries one for desserts.

[geoffcamp]

When I did take tums I found the the smooth dissolve type to be the best tasting.  They came in assorted fruit flavors and were ot as chalky.  Give them a try Angie!

[angieskidney]

When I did take tums I found the the smooth dissolve type to be the best tasting.  They came in assorted fruit flavors and were ot as chalky.  Give them a try Angie!

Good idea! I had just asked the Pharmacist and she said they will work just as well as the ones I already take

[BigSky]

Anyone finding that their CO₂ levels are going below normal since taking Renagel?
Carbon Dioxide Normal = 20 - 30 MEQ/L

Kinda late answer---maybe answer

Anyway low CO2 levels can be caused by too much protein.
 

Considering that most patients have to intake much more protein than "normal" people that may be part of the reason for low Co2 levels.   
Mine runs 13.8.   Normal runs 21-30 with normal for dialysis patients not being less than 12.

[Jill D.]

I take 3 Phoslo with each meal; also pop one if I have a snack and happen to remember! Someone mentioned potassium earlier in this thread - I have to drink 80ml of Sodium Polystyrene Sulfonate (referred to as "K-axcelate") every night as a potassium binder. That is some nasty stuff. Some nights I gag as I try to get it down!

[Zach]

Anyone finding that their CO₂ levels are going below normal since taking Renagel?
Carbon Dioxide Normal = 20 - 30 MEQ/L

Kinda late answer---maybe answer

Anyway low CO2 levels can be caused by too much protein.
 

Considering that most patients have to intake much more protein than "normal" people that may be part of the reason for low Co2 levels.   
Mine runs 13.8.   Normal runs 21-30 with normal for dialysis patients not being less than 12.

When I used Renagel exclusively as my phosphate binder, my CO₂ dropped from an average of 25 down to 17.  I now use 2 PhosLo and 1 Renagel and my CO₂ is back to 22.  I have been consuming the same amount (92 grams) and type of protein during the time that this occurred.

Of course, everyone's different, but ....

To quote K/DOQI Guidelines:

" ... the serum bicarbonate (as total CO₂) should be monitored regularly at monthly intervals and correction of metabolic acidemia by maintaining serum bicarbonate at or above 22 mmol/L should be a goal of the management of individuals undergoing maintenance dialysis."

http://www.kidney.org/professionals/kdoqi/guidelines_updates/nut_a14.html

[goofynina]

When i was on Fosrenol, i never got heartburn, now that i am on Renagel, i get it every night, does anyone else have this problem?  Please Please Please advise,  it's driving me nuts... 

[Zach]

When i was on Fosrenol, i never got heartburn, now that i am on Renagel, i get it every night, does anyone else have this problem?  Please Please Please advise,  it's driving me nuts... 

That's the other reason why I reduced the renagel and added PhosLo.