Hyperphosphatemia remains a major challenge in managing patients with kidney failure and is associated with significant morbidity and mortality. Traditional approaches, such as dietary phosphate restriction, oral phosphate binders, and dialysis modifications, even if combined, often provide insufficient control of serum phosphate levels. Tenapanor, a novel therapy that targets intestinal phosphate absorption, has shown promise in reducing serum phosphate both as monotherapy and in combination with binders, though gastrointestinal side effects may occur.