We read with great interest the report by Elkalashy et al. describing gastrointestinal mucosal injury associated with sevelamer crystal deposition in patients with end-stage kidney disease (ESKD).1 This case series adds to a growing body of evidence suggesting that sevelamer, despite its proven efficacy in phosphate control and vascular calcification reduction, may be linked to rare but clinically significant gastrointestinal complications. The study is valuable in raising clinical awareness; however, several important aspects warrant further discussion.