# A client with CKD stage 5 takes sevelamer for hyperphosphatemia. Which administration instruction is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391825&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with CKD stage 5 takes sevelamer for hyperphosphatemia. Which administration instruction is most important?

## Option

1. Take with each meal to bind dietary phosphate; separate other medications by at least 1 hour before or 3 hours after sevelamer **✔ Correct answer**
2. Take only when symptoms occur
3. Take 2 hours after meals
4. Take on an empty stomach

**Correct answer: 1**

## Explanation

Correct (2): Sevelamer binds dietary phosphate — must take WITH meals to be effective. Separate other medications (especially ciprofloxacin, levothyroxine, mycophenolate, tacrolimus) by ≥1h before or ≥3h after. Common: constipation, dyspepsia. (1,3) Reduces effectiveness. (4) Scheduled.

## In-depth explanation

Memory Tip Phosphate binders = "With meals." Sevelamer (non-calcium, expensive). Calcium acetate (cheap but Ca load). Lanthanum, ferric citrate alternatives.

## Clinical scenario

Scenario 58-year-old male CKD stage 5 on sevelamer 800 mg PO TID. Outpatient teaching.

## Key concepts

- **Sevelamer** — Non-calcium phosphate binder for CKD hyperphosphatemia; separate from interacting drugs.
- **Hyperphosphatemia** — Common in CKD stage 4-5; bone-mineral disorder.
- **Phosphate binders** — Sevelamer, calcium acetate/carbonate, lanthanum, ferric citrate, sucroferric oxyhydroxide.

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