From the FDA Drug Label
The recommended initial dose of calcium acetate for the adult dialysis patient is 2 capsules with each meal. Increase the dose gradually to lower serum phosphorus levels to the target range, as long as hypercalcemia does not develop. Most patients require 3-4 capsules with each meal. The recommended dose of calcium acetate for a patient with End-Stage Renal Disease (ESRD) undergoing dialysis is:
- Initial dose: 2 capsules with each meal
- Maintenance dose: 3-4 capsules with each meal, adjusted to achieve target serum phosphorus levels without developing hypercalcemia 1, 1, 1
From the Research
The recommended dose of calcium acetate for a patient with End-Stage Renal Disease (ESRD) undergoing dialysis is 667 mg (one capsule) taken with each meal, which can be gradually increased to 2-3 capsules per meal as needed to control phosphate levels, with a maximum recommended dose of 1,334 mg (2 capsules) three times daily with meals, as supported by the most recent study 2.
Key Considerations
- Dosing should be individualized based on serum phosphate levels, with the goal of maintaining phosphate between 3.5-5.5 mg/dL.
- Regular monitoring of serum calcium, phosphate, and calcium-phosphate product is essential to avoid hypercalcemia.
- Calcium acetate works by binding to dietary phosphate in the gut, forming insoluble complexes that are excreted in feces, thus reducing phosphate absorption.
- Patients should take calcium acetate with meals for maximum effectiveness and should be advised that constipation is a common side effect.
Supporting Evidence
- A study published in 2013 2 suggests that the average daily dose of calcium acetate or carbonate prescribed in randomized controlled trials to control hyperphosphatemia in dialysis patients ranges between 1.2 and 2.3 g of elemental calcium.
- Another study published in 2002 3 reports on a strategy of partial replacement of calcium with sevelamer for the management of hyperphosphatemia in hypercalcemic chronic HD patients, which may be considered in patients who develop hypercalcemia while taking calcium acetate.
- The use of calcium acetate as a phosphate binder has been shown to be effective in controlling serum phosphate levels in dialysis patients, as demonstrated in a study published in 1991 4 and another study published in 1998 5.