[Management of phosphate in chronic kidney disease--Chemistry and history of phosphate binder].

In 1960s and 1970s when hemodialysis therapy was started in Japan, calcium carbonate was used as a phosphate binder and as the purpose of calcium supplement. Aluminum preparations were widely used in Japan, Europe and United states since the end of 1970s, when these drugs were reported as a strong phosphate binder. After that, some adverse effects such as encephalopathy and bone lesions attributed to Aluminum administration have become serious problems in dialysis patients. As a result, Aluminum administration was prohibited in 1992 in Japan. Oral vitamin D pulse therapy was developed in 1990s as a treatment for secondary hyperparathyroidism in Japan, hypercalcemia have been occurred easily by combination use of vitamin D preparations and calcium carbonate. Since the 2000s, various complications, such as ectopic calcifications, cardiovascular diseases, and reduced life expectancy, which are associated with hypercalcemia and hyperphosphatemia have been clarified. Therefore, sevelamer hydrochrolide, that is non calcium phosphate binder, became available from 2003. Moreover, Lanthanum carbonate, that is another type of non calcium phosphate binder, was effective in Europe and United States, and also developing in Japan. However, there are not any phosphate binders which solved all clinical problems such as phosphate adsorptive power, digestive symptoms, and organ accumulation.