Sevelamer also has pleiotropic effects such as decreasing the phosphaturic hormone fibroblast growth 23 (FGF23), which is secreted by osteocytes and osteoblasts in response to oral phosphate loading and is associated with the development of endothelial dysfunction and cardiac hypertrophy in CKD (23) and regulation of the expression of cell cycle proteins (6), among other effects. This evidence concerns the gene FGF23 and chronic kidney disease.