tenapanor + sevelamer carbonate

Tenapanor + sevelamer carbonate is a **combination therapy** used in adult patients on maintenance dialysis to control **hyperphosphatemia** (elevated serum phosphate levels), especially in those with end-stage kidney disease (ESKD)[1][3][5]. Tenapanor is a **first-in-class, minimally systemic sodium–hydrogen exchanger 3 (NHE3) inhibitor** that reduces intestinal absorption of sodium and phosphate by inhibiting NHE3 in the gut[1][4]. Sevelamer carbonate is a **phosphate binder** that decreases phosphate absorption by binding dietary phosphate in the gastrointestinal tract, preventing its uptake[1][2]. This combination leverages the **distinct mechanisms of action**: tenapanor reduces phosphate absorption via NHE3 inhibition, while sevelamer carbonate binds phosphate in the gut. Clinical trials and preclinical studies demonstrated that the combination can more effectively lower serum phosphate than either agent alone for patients on dialysis[1][2][3][5].