Control of serum P in patient w/ CKD on dialysis; hyperphosphatemia in adult patients receiving haemodialysis or peritoneal dialysis. Adult CKD patient not on dialysis w/ serum P >1.78 mmol/L (5.5 mg/dL).
Initially 2.4-4.8 g daily based on clinical needs & P level; must be taken tid. Patient not taking a phosphate binder w/ serum P >5.5 & <7.5 mg/dL (>1.78 & <2.42 mmol/L) Initially 1 tab tid, ≥7.5 & <9 mg/dL (≥2.42 & <2.91 mmol/L) Initially 2 tab tid, ≥9 mg/dL (≥2.91 mmol/L) Initially 3 tab tid. Patient switching from a Ca-based binder Give sevelamer in equiv dose on a mg for mg wt basis compared to the previous Ca-based binder. Elderly Same as adult dose. Dose may be adjusted accordingly for all patients w/ goal of lowering serum P to ≥1.78 mmol/L (5.5 mg/dL).
Not recommended in adult patients w/ CKD not on dialysis w/ serum P <1.78 mmol/L. Patients w/ dysphagia, swallowing disorders, severe GI motility disorders (including untreated or severe gastroparesis, retention of gastric contents & abnormal or irregular bowel motion), active inflammatory bowel disease, major GIT surgery. Consider using powd for oral susp in patients w/ history of difficulty swallowing. Regularly assess serum vit A, D & E levels & vit K status in patients not taking supplemental vit. Pregnancy. Childn <18 yr.
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