Clinical Investigation

Kidney International (1989) 36, 690–695; doi:10.1038/ki.1989.247

Calcium acetate, an effective phosphorus binder in patients with renal failure

Martin L Mai1, Michael Emmett1, Mudassir S Sheikh1, Carol A Santa Ana1, Lawrence Schiller1 and John S Fordtran1

1Baylor University Medical Center, 3500 Gaston, Dallas, Texas, USA

Correspondence: Michael Emmett MD, Nephrology/Metabolism Division, Baylor University Medical Center, 3500 Gaston, Dallas, Texas 75246, USA.

Received 27 December 1988; Revised 4 May 1989; Accepted 9 May 1989.

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Abstract

Calcium acetate, an effective phosphorus binder in patients with renal failure. Calcium salts are increasingly used as phosphorus binders in patients with chronic renal failure. Calcium carbonate is the principal salt presently utilized, however, other calcium salts may be more effective and safer phosphorus binders. Theoretical calculations, in vitro experiments, and in vivo studies in normal subjects have shown calcium acetate to be a more effective phosphorus binder than other calcium salts. This salt has not previously been studied in patients with chronic renal failure. We used a one-meal gastrointestinal balance technique to measure phosphorus absorption, calcium absorption and phosphorus binding in six patients with chronic renal failure. Calcium acetate was compared with calcium carbonate and placebo. Equivalent doses (50 mEq Ca++) of calcium acetate bound more than twice as much phosphorus (106 plusminus 23 mg) as calcium carbonate (43 plusminus 39 mg) P < 0.05. When phosphorus binding was factored for calcium absorption, calcium acetate bound 0.44 mEq HPO4=/mEq absorbed Ca++ compared with 0.16 mEq HP)4=bound/mEq Ca++absorbed with calcium carbonate. More efficient phosphorus binding permits serum phosphorus concentration to be controlled with lower doses of calcium salts. The higher phosphorus binding/calcium absorption ratio coupled with a lower dose indicates that less calcium will be absorbed when calcium acetate is used for phosphorus control. Markedly positive calcium balance, hypercalcemia and ectopic calcification should be less likely to occur with this drug than other calcium salts.

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