Calcium Binder Calcification Risk — ESENeph MCQ

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EasyChronic Kidney DiseaseCalcium Binder Calcification RiskESENeph

A 55-year-old man with CKD G4 develops hyperphosphataemia. His clinician reviews the available phosphate binders. Which binder has the concern of contributing to cardiovascular calcification?

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Correct answer: B — Calcium-based phosphate binders (Calcium Carbonate, Calcium Acetate) – positive calcium balance may contribute to vascular calcification

Calcium-based phosphate binders provide an exogenous calcium load (up to 1-2 g elemental calcium/day depending on dose). KDIGO 2017 CKD-MBD guideline suggests restricting the dose of calcium-based binders in patients with hypercalcaemia, arterial calcification, or persistently low PTH (adynamic bone disease). The DCOR and other studies showed that Sevelamer was associated with less coronary and aortic calcification progression compared to calcium-based binders. Non-calcium binders (Sevelamer, Lanthanum, Sucroferric oxyhydroxide) are preferred when calcium loading is a concern.

Reference: KDIGO 2017 – CKD-MBD; Block et al 2012 – DCOR Trial