Phosphate binder (calcium-based)
Calcium acetate
Brand names: Phosex, Renacet
Adult dose
Dose: 1–4 tablets with each meal; titrate per phosphate
Route: Oral
Frequency: With meals
Clinical pearls
- NICE NG203 hyperphosphataemia in CKD: calcium-based binder option; KDIGO CKD-MBD
- Risk of vascular calcification — limit total elemental calcium intake to ≤1500mg/day from binders
Contraindications
- Hypercalcaemia
- Hyperphosphataemia (relative — paradoxical)
- Renal stones (calcium-based)
- Severe constipation
Side effects
- Hypercalcaemia
- Constipation
- Nausea
- Vascular calcification (long-term)
Interactions
- Tetracyclines / quinolones / iron / levothyroxine (chelation — separate)
- Bisphosphonates
Monitoring
- Phosphate
- Calcium
- PTH
- Vascular calcification (clinical signs)
Reference: BNF; NICE NG203; KDIGO CKD-MBD; https://bnf.nice.org.uk/drugs/calcium-acetate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- HE-MACS (History and ECG-Based Manchester ACS Risk Score) · ACS Risk Stratification
- Weight-Based Levothyroxine Dose Calculator · Thyroid
- Number Needed to Treat (NNT) / Number Needed to Harm (NNH) · Evidence-Based Medicine
- Hyperkalaemia Management Algorithm · Electrolyte Disorders
- HIV Opportunistic Infection Risk (CD4-Based) · HIV / Immunodeficiency
- Corrected Calcium · Electrolytes
Pathways
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019