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Key Points

  • Combination tablets containing calcium acetate and magnesium carbonate may be at least as effective as sevelamer hydrochloride tablets in lowering serum phosphorus.
  • The study also showed that CaMg provided superior control of serum phosphate in terms of attaining and maintaining phosphorus targets established by the Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes foundation.
  • A cost-analysis showed that CaMg could be a much more cost-effective binder than sevelamer, according to the investigators.

Combination tablets containing calcium acetate and magnesium carbonate (CaMg) may be at least as effective as sevelamer hydrochloride tablets in lowering serum phosphorus, a study found.

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The study also showed that CaMg provided superior control of serum phosphate in terms of attaining and maintaining phosphorus targets established by the Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes foundation.

An international team of investigators compared CaMg (435 mg of calcium acetate [110 mg elemental calcium] and 235 mg of magnesium carbonate [60 mg elemental magnesium]) and sevelamer hydrochloride in a study of 204 hemodialysis or online hemodiafiltration patients.

The 105 patients assigned to receive CaMg and the 99 patients assigned to receive sevelamer hydrochloride were similar with respect to age (59 vs. 56 years, respectively), gender mix, weight, BMI, and years on dialysis.

The starting dose of study drugs was at least four tablets per day. The dose was increased gradually by two to three tablets a day to maintain serum phosphorus values below 1.78 mmol/L. The primary efficacy outcome was serum phosphorus as of week 25.

At week 25, mean serum phosphorus level was 1.7 mmol/L in the CaMg group and 1.77 mmol/L in the sevelamer hydrochloride group. Serum phosphorus was more often within target with CaMg (4.91 visits per patient) than with sevelamer hydrochloride (3.96 visits per patient). The average daily pill intake to achieve target values tended to be higher in the sevelamer hydrochloride than the CaMg group, but not significantly so.

Although total serum calcium increased in the CaMg group, the rise was not clinically relevant, the researchers stated.

They observed an increase in serum magnesium consistent with previous studies of magnesium-containing phosphate binders, but no associated clinical symptoms.

A cost-analysis showed that CaMg could be a much more cost-effective binder than sevelamer, according to the investigators.

The researchers concluded that CaMg “could be a promising new option in the treatment of hyperphosphatemia.”