From the Guidelines
Phoslo (calcium acetate) should not be used as a first-line treatment for hyperphosphatemia in patients with chronic kidney disease (CKD) due to the potential harm of liberal calcium exposure, as suggested by recent studies 1. When considering the use of Phoslo, it is essential to weigh the benefits and risks, particularly in patients with CKD who are not receiving dialysis. The current evidence suggests that excess exposure to calcium may be harmful across all GFR categories of CKD 1. Key points to consider when using Phoslo include:
- Phoslo is a calcium-based phosphate binder that can decrease serum phosphate concentrations and urinary phosphate excretion 1
- However, its use has been associated with progression of coronary and aortic calcification, particularly in patients with normal phosphate concentrations at baseline 1
- The recommendation is to use phosphate-lowering therapies only in the event of progressive or persistent hyperphosphatemia, and not for prevention 1
- Calcium-free phosphate-binding agents may be a safer alternative to calcium-based agents like Phoslo for the treatment of hyperphosphatemia 1 In clinical practice, Phoslo may still be used in certain situations, but its use should be carefully considered and monitored, taking into account the potential risks and benefits, as well as the individual patient's condition and response to treatment.
From the FDA Drug Label
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).
- Phoslo (calcium acetate) is used for the reduction of serum phosphorus in patients with end stage renal disease 2 2.
- The main purpose of Phoslo is to act as a phosphate binder.
From the Research
Phosphate Binders and Their Use
- Phosphate binders, such as Phoslo, are used to control serum phosphate levels in patients with chronic kidney disease (CKD) and those on dialysis 3, 4, 5, 6, 7.
- Hyperphosphatemia, or elevated phosphate levels, can lead to secondary hyperparathyroidism, cardiovascular and soft tissue calcifications, and increased mortality risk 3, 5, 7.
Mechanism of Action
- Phosphate binders work by binding to phosphate in the gut and preventing its absorption into the bloodstream 3, 4, 7.
- Different types of phosphate binders are available, including calcium-based and non-calcium-based binders, each with their own benefits and drawbacks 4, 5, 7.
Clinical Use
- Phosphate binders are commonly prescribed to patients with CKD and those on dialysis to control phosphate levels and prevent complications 4, 5, 6.
- The choice of phosphate binder depends on various factors, including the patient's phosphate level, calcium level, and other medical conditions 4, 7.
- Dietary restriction of phosphate intake is also an important aspect of managing hyperphosphatemia, but may be difficult to follow long-term 3, 5, 6.