Chronic kidney disease (CKD) is a global public health problem. Metabolic bone disease and mineral metabolism disturbance are common disturbance of CKD. A critical role of phospohorus in metabolic bone disease, i.e. secondary hyperparatyhroidism is well known. There is growing evidence that hyperphosphatemia isa strong predictor of mortality in CKD, i.e. is a novel risk factor for vascular calcification, left ventricular hypertrophy and kidney disease progression. Prevention and treatment of phosphate disturbace in CKD is still great challenge and new phosphate binders ofer new and advanced possibilites.