Compare Renagel (Sevelamer) with Alternatives for Managing High Phosphorus Levels

If you're managing chronic kidney disease, you know high phosphorus levels can be dangerous. Left unchecked, they can weaken your bones, harm your heart, and speed up kidney damage. That’s where phosphate binders like Renagel (sevelamer) come in. But Renagel isn’t the only option. Many patients and doctors look at alternatives because of cost, side effects, or how well the drug works for their body. So what’s really out there? And which one might be better for you?

What is Renagel (Sevelamer) and how does it work?

Renagel is the brand name for sevelamer carbonate. It’s a phosphate binder - meaning it doesn’t get absorbed into your bloodstream. Instead, it sticks to the phosphorus in your food as it passes through your gut and carries it out of your body in your stool. This keeps your blood phosphorus levels from spiking after meals.

It’s taken with meals, usually three times a day. The typical starting dose is 800 mg per meal, but your doctor will adjust based on your blood tests. Renagel comes in tablets and capsules. It’s often prescribed for adults with chronic kidney disease on dialysis, but some non-dialysis patients use it too.

One big plus? It doesn’t contain calcium or aluminum, so it won’t add to calcium buildup in your blood vessels - a real risk with older binders. It also doesn’t raise your blood calcium levels, which helps protect your heart.

Why look for alternatives to Renagel?

Even though Renagel works well for many, it’s not perfect. The most common complaints are stomach issues: nausea, vomiting, constipation, or bloating. Some people say it’s hard to swallow the large pills. And then there’s the price - Renagel can cost over $500 a month without insurance.

Many patients try alternatives because:

• They can’t tolerate the side effects
• They need a cheaper option
• They’re on multiple pills and want to reduce pill burden
• They’re not hitting their phosphorus target with Renagel alone

There are several other phosphate binders approved by the FDA. Let’s break them down.

Calcium-based binders: Calcium acetate and calcium carbonate

These are the oldest and cheapest options. Calcium acetate (PhosLo, Calphron) and calcium carbonate (Tums, generic) work by binding phosphorus the same way Renagel does - but they also release calcium into your blood.

That’s a double-edged sword. For people with low calcium, this helps. But for those with kidney disease, extra calcium can build up in arteries and heart valves. Studies show calcium-based binders increase the risk of vascular calcification by 20-30% compared to non-calcium options like sevelamer.

Calcium acetate costs about $20-$40 a month. Calcium carbonate (Tums) can be under $10. But if your blood calcium is already high, or you have heart disease, these aren’t safe long-term choices.

Iron-based binders: Sucroferric oxyhydroxide (Velphoro)

Velphoro is a newer option. It’s a chewable tablet that looks like a candy. You chew it with meals - no swallowing big pills. It binds phosphorus and also delivers iron, which many kidney patients are low on.

A 2023 study in the American Journal of Kidney Diseases found Velphoro lowered phosphorus just as well as sevelamer, but with fewer GI side effects. About 15% of users reported nausea, compared to 25% on Renagel. Constipation was also less common.

The catch? It’s expensive - around $450-$600 a month. But if you struggle with pill burden or need iron support, it’s a strong contender. It’s also taken fewer times a day (two to three times) compared to Renagel’s three to four.

Lanthanum carbonate (Fosrenol)

Fosrenol is another non-calcium, non-aluminum binder. It comes as a chewable tablet or powder you mix with water. Like Velphoro, you chew it with meals. It’s very effective at lowering phosphorus - often more so than sevelamer in head-to-head trials.

A 2022 meta-analysis in Nephrology Dialysis Transplantation showed lanthanum lowered phosphorus by an average of 1.8 mg/dL more than sevelamer over six months. It also had lower rates of diarrhea and bloating.

But it has its own issues. Some people don’t like the chalky taste. And there’s a rare but serious concern: lanthanum can build up in the body over years. Long-term studies (over 10 years) show it stays in the liver and spleen, but no clear harm has been proven yet. Still, many doctors avoid it in younger patients.

Cost-wise, Fosrenol is about $300-$500 a month. Generic versions are available, which helps.

Non-prescription options: Diet and lifestyle

Medications aren’t the whole story. About 30-50% of your phosphorus comes from food. No binder can fully block it if you’re eating a lot of processed foods.

Phosphorus additives in sodas, fast food, packaged snacks, and processed meats are especially bad. They’re 90% absorbable - meaning your body takes nearly all of it. Natural phosphorus in meat or dairy is only 40-60% absorbable.

Simple changes help:

• Avoid colas and energy drinks
• Choose fresh meats over deli meats
• Use herbs instead of seasoning packets
• Check labels for “phos” in ingredients

One patient, 58-year-old Maria from Ohio, cut her Renagel dose in half after switching to whole foods and ditching soda. Her phosphorus dropped from 6.2 to 4.8 mg/dL - without any side effects.

Side-by-side comparison: Renagel vs. Alternatives

Here’s how the main options stack up:

Who should avoid Renagel?

Renagel isn’t right for everyone. Avoid it if:

• You have a bowel obstruction - it can worsen it
• You’re allergic to sevelamer
• You’re on a very low-calorie diet and can’t swallow large pills
• You’re already taking a lot of other pills and can’t handle more

If you’re on dialysis and your phosphorus is still high despite taking Renagel, your doctor might add a second binder - like a low-dose calcium-based one - or switch you entirely.

What do patients say?

In online forums and patient surveys, the top three complaints about Renagel are:

1. “I feel sick after taking it.”
2. “It’s too expensive.”
3. “I can’t swallow the pills.”

Patients who switched to Velphoro often say: “I can chew it like gum. No stomach pain. I actually take it.” Those on Fosrenol say: “It works better, but the taste is awful.” Calcium users say: “It’s cheap, but my doctor keeps telling me to stop.”

Real change comes from personalization. One patient switched from Renagel to Fosrenol and cut her pill count from 12 to 6 a day. Another switched to calcium acetate and saved $500 a month - but had to get monthly heart scans to check for calcification.

How to talk to your doctor about alternatives

Don’t just ask, “What else can I take?” Instead, say:

• “I’m having trouble with stomach side effects. Are there options that are gentler?”
• “I’m struggling to afford this. Is there a generic or cheaper alternative?”
• “I’m taking 10 pills a day. Is there a way to reduce that?”
• “My phosphorus is still high. Should we try something stronger?”

Your doctor can check your blood levels, review your diet, and see what’s working. They may also check your insurance formulary - some plans cover Velphoro or Fosrenol better than Renagel.

Final thoughts

Renagel is a solid choice for keeping phosphorus low without raising calcium. But it’s not the only option - and it’s not always the best. For some, chewable binders like Velphoro or Fosrenol are easier to take and cause fewer stomach issues. For others, calcium-based binders make sense if they’re carefully monitored.

The key is matching the drug to your life - not just your lab numbers. If you’re struggling with Renagel, don’t suffer in silence. Ask for alternatives. Your body, your wallet, and your daily comfort all matter.