From the Guidelines
Calcium acetate should be used with caution in patients with chronic kidney disease, as it may cause progression of coronary and aortic calcification, and its use should be individualized based on serum phosphate levels and the risk of calcium overload 1.
Key Points
- Calcium acetate is a phosphate binder used to control high phosphate levels in patients with chronic kidney disease.
- The typical starting dose is 667 mg taken with each meal, which can be increased gradually based on serum phosphate levels.
- Calcium acetate works by binding to dietary phosphate in the gut, forming an insoluble compound that is excreted in feces.
- Common side effects include constipation, nausea, and hypercalcemia.
- Regular monitoring of serum calcium and phosphate levels is essential while using this medication.
- Patients should maintain adequate hydration and report symptoms of hypercalcemia such as confusion, muscle weakness, or irregular heartbeat.
Considerations
- Calcium acetate may cause progression of coronary and aortic calcification, particularly in patients with normal phosphate concentrations at baseline 1.
- The use of calcium-based phosphate binders should be restricted in patients with hyperphosphatemia across the CKD spectrum 1.
- Phosphate-lowering treatment decisions should be individualized based on progressively or persistently elevated serum phosphate levels 1.
- The current evidence suggests that excess exposure to calcium may be harmful across all GFR categories of CKD 1.
From the FDA Drug Label
Calcium acetate acts as a phosphate binder. 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).
Calcium acetate is a phosphate binder. It is used to control hyperphosphatemia in patients with end-stage renal failure or end-stage renal disease (ESRD) by reducing serum phosphorus levels 2, 2, 2.
From the Research
Calcium Acetate Binder
- Calcium acetate is a phosphate binder used to control phosphorus levels in patients with chronic kidney disease (CKD) 3, 4.
- It has been shown to be more effective at binding phosphorus than other calcium salts, such as calcium carbonate 4.
- Calcium acetate has a higher phosphorus binding/calcium absorption ratio, which may reduce the risk of hypercalcemia and ectopic calcification 4.
- However, long-term data on the safety and efficacy of calcium acetate are limited, and it may lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification 3.
Comparison with Other Phosphate Binders
- Non-calcium-based phosphate binders, such as sevelamer carbonate, may have a lower risk of vascular calcification and mortality compared to calcium-based binders like calcium acetate 5, 6.
- Lanthanum carbonate, a non-calcium-based phosphate binder, has been shown to have a lower risk of hypercalcemia and may improve nutritional status and cardiac function compared to calcium-containing binders 7.
- Sevelamer carbonate has been shown to have favorable effects on anti-inflammatory and vascular calcification biomarkers compared to calcium acetate 6.
Safety and Efficacy
- Calcium acetate is generally well-tolerated, but may cause gastrointestinal side effects such as nausea and constipation 4.
- Lanthanum carbonate has been associated with a lower risk of adverse effects, such as nausea and gastrointestinal obstruction, compared to other phosphate binders 7.
- The safety and efficacy of calcium acetate and other phosphate binders may vary depending on the individual patient and the specific clinical context 3, 5, 6, 7.