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KHK7791 + phosphate binders refers to the combination therapy of **tenapanor** (code name KHK7791), a first-in-class, oral, small-molecule phosphate absorption inhibitor, together with established **phosphate binders** (such as sevelamer, calcium-based binders, iron-based binders, etc.) for the treatment of **hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis**. Tenapanor acts primarily by inhibiting the sodium/hydrogen exchanger 3 (NHE3) on the intestinal lining, which reduces dietary phosphate absorption via the paracellular pathway. Phosphate binders work by binding dietary phosphate in the gastrointestinal tract to prevent its absorption. The rationale for combining these therapies is that they have **different and complementary mechanisms of action**, leading to better serum phosphate control for patients who are not adequately managed on phosphate binders alone. Clinical trials have demonstrated that dual therapy provides a **greater reduction in serum phosphorus levels** than phosphate binders alone, with the main side effect being increased gastrointestinal events, most notably diarrhea.
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