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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It provides a high calcium content (approx. 25%) and is highly soluble, making it effective at binding dietary phosphate in the gut to form insoluble calcium phosphate for fecal excretion.
## Primary Indications
* Control of hyperphosphatemia in adult and pediatric patients with end-stage renal disease (ESRD) or chronic kidney disease on dialysis.
## Adult Dosing
* **Initial dose:** 1,334 mg (2 capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels. Most patients require 2–4 capsules/tablets per meal to achieve target phosphate levels.
* **Maximum:** Dosing is generally limited by the development of hypercalcemia.
## Pediatric Dosing
* **Dosing:** No specific FDA-labeled pediatric dosing is established.
* **Common Practice:** Dosing is often weight-based or titrated starting at 20–50 mg/kg/day divided with meals, not exceeding adult maximums. **Consult institution-specific protocols or pediatric nephrology guidelines prior to administration.**
## Dose Adjustments
* **Renal Impairment:** Required for all patients on dialysis.
* **Hypercalcemia:** If hypercalcemia develops, reduce or discontinue the dose; consider switching to a non-calcium-based phosphate binder (e.g., sevelamer or lanthanum).
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Nephrolithiasis (calcium-containing stones).
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic calcification (if calcium-phosphate product > 55 mg²/dL²), severe hypercalcemia symptoms (confusion, cardiac arrhythmias, lethargy).
## Key Drug Interactions
* **Quinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Oral absorption may be reduced. Separate by at least 4 hours.
* **Bisphosphonates:** Calcium can reduce absorption. Separate by at least 2 hours.
## Monitoring
* **Serum Calcium:** Monitor weekly during initiation and dose titration; then periodically.
* **Serum Phosphate:** Monitor periodically to ensure efficacy.
* **Calcium-Phosphate Product (Ca × PO4):** Goal typically < 55 mg²/dL².
* **Signs of Hypercalcemia:** Monitor for muscle weakness, cardiac irregularities, or mental status changes.
## Clinical Pearls
* **Timing is critical:** Must be taken *with* meals to bind dietary phosphorus; taking between meals yields no benefit for phosphate binding.
* **Calcium Burden:** Assess total daily calcium intake (including supplements and dialysate) to avoid accidental overdose of calcium, which risks vascular and soft tissue calcification.
* **Patient Education:** Ensure patients understand that this medication is NOT a calcium supplement for bone health but a binder for food.
***
**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Clinical practice and institutional protocols vary. Always verify current prescribing information, package inserts, and local clinical guidelines before prescribing or administering medication.
