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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
Dosing is individualized based on serum phosphate levels and dietary phosphate intake.
* **Starting dose:** Typically 667 mg to 1333 mg (1 to 2 tablets) administered orally with each meal.
* **Titration:** Dose may be increased gradually.
* **Maximum dose:** No specific maximum dose is established, but aim to maintain serum phosphate < 6 mg/dL. Monitor for hypercalcemia.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under the guidance of a nephrologist. Limited studies suggest doses of 10-30 mg/kg/day divided with meals.
## Dose Adjustments
* **Renal Impairment:** Dosing is initiated in the context of CKD. Careful monitoring is essential to avoid hypercalcemia.
* **Hepatic Impairment:** No specific adjustments are typically needed, as the primary concern is calcium and phosphate levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that may lead to hypercalcemia (e.g., sarcoidosis, certain malignancies).
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, headache, confusion, lethargy, muscle weakness, frequent urination, thirst), hypophosphatemia.
* **Serious:** Severe hypercalcemia, cardiac arrhythmias, kidney stones.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium acetate can impair the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium acetate can reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Hypercalcemia can potentiate the effects of calcium channel blockers.
* **Digitalis Glycosides:** Hypercalcemia can increase the risk of digitalis toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing and assess efficacy. Target < 6 mg/dL.
* **Serum Calcium:** Monitor regularly to prevent and detect hypercalcemia. Target: generally < 11 mg/dL, but may vary by institution.
* **Serum Magnesium and Alkaline Phosphatase:** Monitor periodically.
* **Aluminum, Calcium, and Magnesium levels in dialysate:** For patients on peritoneal dialysis.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia, especially in patients with a history of kidney stones or other conditions predisposing to hypercalcemia.
* Ensure patients understand the importance of consistent dosing with meals.
* Educate patients on dietary phosphate restriction.
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*This information is intended for clinical decision-making and does not replace the need to consult the most current prescribing information and relevant clinical guidelines.*
