What are aluminum based binders?
In the early 1970s, aluminum hydroxide was one of the major binders used in the treatment of hyperphosphatemia in dialysis patients. It was assumed that most of the aluminum would bind to phosphorus and would be excreted in feces; however, aluminum accumulated in the CNS causes dementia, and aluminum accumulated in the bone results in osteomalacia and anemia. A more aggressive form of this dementia, called dialysis encephalopathy, presents as acute encephalopathy, with seizures and sometimes respiratory failure. Currently, the National Kidney Foundation guidelines recommend the use of aluminum only in patients who have an elevated phosphorus >7 mg/dL (2.3 mmol/L), refractory to other binders, and only for a limited time period (<4 weeks).