Renagel (sevelamer hydrochloride) is one of the most utilized phosphate binders in the U.S., though its superiority compared to other (and cheaper) phosphate binders remains controversial. One of the theoretical benefits of using Renagel is that it should not contribute to hypercalcemia, a possible side effect of the common calcium-containing phosphate binders (e.g., calcium acetate, calcium carbonate), which could possibly contribute to the increased vascular calcification seen in ESRD patients.
One of the drawbacks of using sevelamer hydrochloride–particularly in advanced CKD patients who have not yet reached dialysis–is its tendency to cause a metabolic acidosis, based on the hydrochloride moiety which forms the salt. To get around this, the drug company (Genzyme) has manufactured another form of sevelamer, this time conjugated to carbonate. The drug (sevelamer carbonate) is being marketed under the name “Renvela”. We’ll see how it works.