Efficacy of colestilan in the treatment of hyperphosphataemia in renal disease patients

Introduction: Hyperphosphataemia is common in chronic kidney disease (CKD), particularly in the late stages and is associated with secondary hyperparathyroidism, abnormal bone mineralisation and increased cardiovascular morbidity/mortality. At present, there is a range of phosphate binders designed to keep serum phosphate at normal or near normal levels. Colestilan is a new binder that offers additional actions that may afford further benefits over simply lowering phosphate.

Areas covered: This paper reviews the pharmacology and clinical data currently available in the use of colestilan to treat hyperphosphataemia in CKD stage 5 patients on dialysis.

Expert opinion: Available phosphate binders lower serum phosphorus levels to a clinically relevant extent. The balance between the risks and the potential benefits associated with each agent must be considered when choosing a binder. Calcium-based binders can lead to hypercalcaemia and/or positive calcium balance and cardiovascular calcification. Like sevelamer, colestilan is not absorbed and there is no evidence of any risk of hypercalcaemia. In addition, a significant lowering of low-density lipoprotein-cholesterol, similar to simvastatin, a reduction in plasma uric acid and a reduction in high glycosylated haemoglobin values suggest additional beneficial actions that may convert to reductions in mortality.