Fibroblast growth factor-23, play an important role in atherosclerosis, endothelial dysfunction and vascular calcification. Sevelamer can improve vascular calcification, serum uric acid, low-density lipoprotein-cholesterol and Fibroblast growth factor-23. Aim of study Assessment the effect of sevelamer as phosphate binder against calcium carbonate on Fibroblast growth factor-23. Methods A prospective open-labelled study that included patients on hemodialysis. A total of 72 patients were screened, only 53 patients completed the 10 week period. Adults patients with serum phosphate as> 5.5 mg/dl were included. There were Group1: Includes 28 patients (19 males and 9 females receiving sevelamer carbonate (Renvela) tablet. Group 2: Include 25patients (17 male and 8 female) receiving calcium carbonate tablet. Level of serum calcium, phosphorus, albumin, at pre wash, baseline and every 5 weeks, meanwhile the Level Low-density lipoprotein, Fibroblast growth factor23, and parathyroid hormone were measured at baseline and after 10 weeks. Results Serum phosphorus was significantly reduced after 10 weeks with both sevelamer carbonate-22.4% and calcium carbonate-23.5%. Serum parathyroid was significantly reduced in both groups. Only group 1 was associated with significant reduction in low-density lipoprotein cholesterol by 26.4% from base line, significant reduction in Fibroblast growth factor-23 level by-31.2% and significant decrease in Calcium× phosphate product-29.5%. Significant rise in the serum calcium in group 2 patients (14.34%). Conclusion Sevelamer superior to calcium-based binders in reducing hypercalcemia and …