From the Guidelines
Calcium acetate is recommended as a first-line treatment for managing high phosphate levels in patients with kidney disease, with a typical dosage of 667 mg tablets (containing 169 mg of elemental calcium) taken 2-3 times a day with meals. This medication works by binding to phosphate in the digestive tract, preventing its absorption into the bloodstream 1. Patients should take calcium acetate with meals for maximum effectiveness in binding dietary phosphate. Common side effects include constipation, nausea, and hypercalcemia (high calcium levels) 1. It's essential for patients to follow their prescribed dosage carefully and have regular blood tests to monitor phosphate and calcium levels.
Key Considerations
- Calcium acetate is preferred over calcium carbonate in many cases because it provides less elemental calcium while still effectively binding phosphate, reducing the risk of calcium buildup in the body 1.
- The total calcium intake from diet, calcium-containing phosphate binders, and dialysate should ideally be equal to the recommended daily adequate intake (AI) for adults (1,000 to 1,500 mg/day) 1.
- In patients with low PTH levels, the dosage of calcium-based phosphate binders should be reduced to avoid critical accumulation of calcium 1.
- To minimize the risk of hypercalcemia, patients should be monitored regularly, and their calcium intake should be adjusted accordingly 1.
Dosage and Administration
- The typical dosage of calcium acetate is 667 mg tablets (containing 169 mg of elemental calcium) taken 2-3 times a day with meals.
- The dosage may be adjusted based on serum phosphate levels, and patients should be monitored regularly to avoid hypercalcemia.
- Calcium acetate should be taken with meals to maximize its effectiveness in binding dietary phosphate.
Monitoring and Follow-up
- Patients should have regular blood tests to monitor phosphate and calcium levels.
- The dosage of calcium acetate should be adjusted based on the results of these blood tests to avoid hypercalcemia and ensure effective phosphate binding.
- Patients should be educated on the importance of adhering to their prescribed dosage and attending regular follow-up appointments to monitor their condition.
From the FDA Drug Label
Calcium acetate capsules are administered orally for the control of hyperphosphatemia in end-stage renal failure. Calcium acetate capsules are a phosphate binder indicated for the reduction of serum phosphorus in patients with end stage renal disease. Calcium acetate capsules are a phosphate binder indicated to reduce serum phosphorus in patients with end stage renal disease (ESRD).
The main use of calcium acetate is as a phosphate binder to reduce serum phosphorus in patients with end-stage renal disease 2, 2, 2.
From the Research
Calcium Acetate Overview
- Calcium acetate is a phosphate binder used to control serum phosphorus levels in patients with chronic kidney disease (CKD) 3, 4, 5, 6.
- It is effective in reducing serum phosphorus and intact parathyroid hormone (iPTH) levels in CKD patients not yet on dialysis 3.
- Calcium acetate is also used in patients with end-stage renal disease (ESRD) on maintenance hemodialysis to control hyperphosphatemia 4.
Efficacy and Safety
- Studies have shown that calcium acetate is more effective than sevelamer in controlling serum phosphorus and Ca x P product in hemodialysis patients 4.
- However, calcium acetate can lead to hypercalcemia and/or positive calcium balance, which may contribute to cardiovascular calcification 5, 6.
- The safety profile of calcium acetate is generally considered acceptable, with adverse events similar to those of placebo 3.
Comparison with Other Phosphate Binders
- Calcium acetate has been compared to other phosphate binders, including sevelamer, lanthanum, and iron-based binders 4, 5, 6.
- Non-calcium-based phosphate binders, such as sevelamer, may have a reduced risk of cardiovascular calcification and mortality compared to calcium-based binders 7.
- The choice of phosphate binder depends on individual patient needs and factors such as cost, efficacy, and safety profile 4, 5, 6.