Hyperphosphatemia, a nearly universal complication of kidney failure, is accompanied by hypocalcemia and low serum levels of vitamin D. Without treatment, these deficiencies usually lead to severe secondary hyperparathyroidism, which in turn leads to painful fractures, brown tumors, and generalized osteopenia. Dietary restriction of phosphate has long been the cornerstone of therapy, but this measure is usually not sufficient to control hyperphosphatemia. As a result, oral phosphate binders are used in over 90% of patients with kidney failure, at an annual cost of approximately $750 million (in U.S. dollars) worldwide.

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