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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It provides approximately 25% elemental calcium by weight. Unlike calcium carbonate, it binds phosphate more effectively in a wider pH range. ## Primary Indications * Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) secondary to chronic kidney disease (CKD). ## Adult Dosing * **Initial Dose:** 667 mg to 1,334 mg (1 to 2 capsules/tablets) orally with each meal. * **Titration:** Adjust based on serum phosphorus levels. * **Maximum Dose:** Typically capped at 6–8 tablets/capsules per day, but dosing must be titrated to achieve desired serum phosphorus while avoiding hypercalcemia. ## Pediatric Dosing * **Safety/Efficacy:** Well-established for pediatric ESRD, though dosing is highly individualized based on serum phosphate and calcium levels. * **Typical Dose:** 800–1,600 mg/m²/day divided with meals. Dosing should be managed by a pediatric nephrologist; always refer to facility-specific protocols. ## Dose Adjustments * **Hypercalcemia:** Reduce dose or discontinue if serum corrected calcium exceeds 10.5 mg/dL. * **Hypophosphatemia:** Reduce or discontinue dose if serum phosphorus drops below target range. * **Renal/Hepatic:** No specific adjustments, but ESRD status is the primary indication. ## Contraindications * Hypercalcemia. * Hypophosphatemia. * Known hypersensitivity to calcium salts. ## Adverse Effects * **Common:** Hypercalcemia, nausea, vomiting, constipation. * **Serious:** Metastatic soft tissue calcification (due to elevated calcium-phosphorus product). ## Key Drug Interactions * **Fluoroquinolones & Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2–4 hours. * **Levothyroxine:** Calcium interferes with absorption. Separate by at least 4 hours. * **Bisphosphonates:** Reduced absorption. Separate by at least 2 hours. * **Digoxin:** Potential for increased digitalis toxicity if hypercalcemia develops. ## Monitoring * **Serum Phosphorus:** Monitor at least monthly during titration. * **Serum Calcium:** Monitor weekly/bi-weekly during initial titration. * **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize the risk of metastatic calcification. ## Clinical Pearls * **Timing is critical:** Must be taken *with* meals to bind dietary phosphorus. Taking it between meals is ineffective for phosphate control and increases the risk of hypercalcemia. * **Patient Education:** Advise patients to avoid taking additional calcium-containing supplements or antacids without clinician approval to prevent hypercalcemia. * **Superiority:** Calcium acetate has a higher binding capacity per gram and is more soluble than calcium carbonate. *** *Disclaimer: This information is for educational purposes only. Dosing standards and clinical guidelines may change. Always verify current prescribing information, drug monographs, and institutional protocols before administering medication.*