Treatment algorithm for control of hyperphosphataemia in adults with CKD Dietary restriction inadequate, phosphate still high Calcichew® (chewable calcium carbonate) 500 mg Ca2+ Max 3 tablets/24h First line: Osvaren® Calcium acetate/magnesium carbonate 110 mg Ca2+ Maximum 12 tablets / 24 hours Low Ca2+ High Mg2+ Osvaren dose optimised Check concordance Phosphate still high Calcium high Target ranges: CKD stage (3- 5 pre-dialysis) Phosphate: 0.8 to 1.5 mmol/l C. Calcium: 2.1 to 2.5 mmol/l CKD stage 5 (on dialysis) Phosphate: 1.1 to 1.7 mmol/l Sevelamer (Renvela®) 2.4 – 4.8g / 24hours Tablet or sachet Lanthanum (Fosrenol®) 1.5g – 3g / 24 hours Chewable / sachet NICE Clinical guideline CG157 - Hyperphosphataemia in Chronic kidney disease March 2013