From the Guidelines
The treatment for hyperphosphatemia should focus on patients with overt hyperphosphatemia, and treatment approaches should be based on serial assessments of serum phosphate, calcium, and parathyroid hormone levels taken together. The goal of treatment is to reduce serum phosphate levels through dietary restriction, phosphate binders, and addressing the underlying cause. Key aspects of treatment include:
- Dietary phosphate restriction to 800-1000 mg/day by reducing intake of high-phosphate foods like dairy products, processed foods, and cola beverages.
- Use of phosphate binders, which are the mainstay of treatment and should be taken with meals.
Options for phosphate binders include:
- Calcium-based binders (calcium carbonate 500-1500 mg with meals or calcium acetate 667-1334 mg with meals), which are effective but may increase calcium load.
- Non-calcium options like sevelamer (800-1600 mg with meals), lanthanum carbonate (500-1000 mg with meals), or iron-based binders like ferric citrate (1-2 tablets with meals).
- In severe cases, dialysis may be necessary, particularly in patients with kidney failure.
- For those with vitamin D-related hyperphosphatemia, reducing vitamin D supplements is important.
- Treating the underlying condition, such as improving kidney function or addressing hormonal imbalances like hypoparathyroidism, is crucial for long-term management. Regular monitoring of serum phosphate, calcium, and parathyroid hormone levels is essential to adjust treatment and prevent complications like soft tissue calcification and secondary hyperparathyroidism, as supported by the studies 1.
From the FDA Drug Label
Calcium acetate capsules are administered orally for the control of hyperphosphatemia in end-stage renal failure. Calcium acetate acts as a phosphate binder. When taken with meals, combines with dietary phosphate to form an insoluble calcium phosphate complex, which is excreted in the feces, resulting in decreased serum phosphorus concentration.
The treatment for hyperphosphatemia is calcium acetate administered orally, which acts as a phosphate binder to decrease serum phosphorus levels 2.
- Key points:
- Calcium acetate is used for the control of hyperphosphatemia in end-stage renal failure.
- It combines with dietary phosphate to form an insoluble complex that is excreted in the feces.
- This results in decreased serum phosphorus concentration.
- The initial starting dose is typically 2 tablets per meal for 3 meals a day, and the dose is adjusted as necessary to control serum phosphorus levels 2.
- Main idea: Calcium acetate is effective in decreasing serum phosphorus levels in patients with end-stage renal disease 2.
From the Research
Treatment Options for Hyperphosphatemia
The treatment for hyperphosphatemia, a condition characterized by high levels of phosphorus in the blood, typically involves a combination of dietary restrictions, phosphate binders, and dialysis for patients with chronic kidney disease (CKD) [ 3, 4, 5, 6, 7 ].
- Dietary Restrictions: Limiting dietary phosphate intake is crucial in managing hyperphosphatemia. This can be challenging due to the high phosphate content in many processed foods [ 7 ].
- Phosphate Binders: These are medications that bind to phosphate in the gut, preventing its absorption into the bloodstream. Common phosphate binders include calcium-based salts (like calcium acetate and calcium carbonate), sevelamer, lanthanum carbonate, and magnesium salts [ 4, 5, 6 ].
- Dialysis: For patients with end-stage renal disease, dialysis is necessary to remove excess phosphate from the blood [ 4, 7 ].
Selection of Phosphate Binders
The choice of phosphate binder should be individualized, considering the patient's clinical context, costs, and tolerability, as well as the effects on other parameters of mineral metabolism [ 4 ].
- Calcium-Based Binders: Effective but can lead to hypercalcemia and positive calcium balance [ 4, 5 ].
- Non-Calcium-Based Binders: Include sevelamer, lanthanum carbonate, and magnesium salts, each with its own profile of efficacy and potential side effects [ 4, 5 ].
Importance of Early Intervention
Early phosphate control may help reduce the clinical consequences of CKD-mineral and bone disorder (MBD), including bone disease, vascular calcification, and cardiovascular disease [ 3 ]. Achieving normal phosphorus levels is associated with distinct clinical benefits, although this can be more challenging in dialysis patients [ 3 ].