Expert opinion on the optimal use of sevelamer in clinical practice in Southeast Asia

Chronic kidney disease (CKD)-mineral bone disorder (MBD) is a prevalent and serious complication in patients with advanced CKD, particularly in Southeast Asia where the disease burden is high. This condition significantly increases the risk of cardiovascular events and mortality. This review synthesizes mechanistic insights, clinical trial evidence, guideline recommendations, and expert perspectives to evaluate the role of sevelamer, a non-calcium-based phosphate binder, in the management of CKD-MBD. Regional epidemiological and clinical practice data from Southeast Asia were also examined. Sevelamer effectively controls hyperphosphatemia without exacerbating hypercalcemia or vascular calcification. Beyond phosphate binding, it offers pleiotropic benefits including improvements in lipid profile, reductions in vascular inflammation, and potential survival advantages. Despite challenges such as higher cost and pill burden, long-term safety and efficacy have been consistently demonstrated, particularly in high-risk CKD populations. Sevelamer represents a preferred therapeutic option in the management of CKD-MBD due to its efficacy and favorable safety profile. Insights from Southeast Asia highlight the need for improved accessibility, physician education, and supportive health policies to optimize its use in real-world practice.