1. 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