All of the following is not a phosphate binder EXCEPT:

• A. Renagel
• B. Phos-Lo
• C. Tums
• D. Vitamin B12

Answer: (D)

Phosphate binders are medications used in kidney disease to prevent dietary phosphate from being absorbed in the gut, helping control serum phosphate levels. Among the options, Renagel (sevelamer) is a non-calcium phosphate binder, Phos-Lo (calcium acetate) is a phosphate binder, and Tums (calcium carbonate) also acts as a phosphate binder. Vitamin B12 is a vitamin supplement with no role as a phosphate binder. So Vitamin B12 is not a binder, while the other three options do bind phosphate. The wording of the question can be a bit odd since several choices are phosphate binders, but the key idea is identifying which agents actually bind phosphate versus which do not.