Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis

N Engl J Med. 1986 Jul 17;315(3):157-61. doi: 10.1056/NEJM198607173150304.


Phosphate binders that contain aluminum are frequently prescribed to treat hyperphosphatemia in patients with chronic renal failure, but an accumulation of aluminum can lead to osteomalacia. To evaluate the efficacy of calcium carbonate as an alternative phosphate binder, we studied 20 patients maintained on dialysis during three consecutive periods. In period 1, the patients took aluminum hydroxide for a month (mean dose, 5.6 g per day; range, 1.5 to 14.0). In period 2, they took no phosphate binders for a month, and in period 3, they took calcium carbonate (Os-Cal) for two months (mean dose, 8.5 g per day; range, 2.5 to 17). The mean (+/- SE) serum calcium level during period 1 was 9.6 +/- 0.2 mg per deciliter; this decreased slightly (to 9.3 +/- 0.1) during period 2 and increased to 10.0 +/- 0.2 during period 3. The mean (+/- SE) serum phosphorus level during period 1 was 4.8 +/- 0.1 mg per deciliter; this increased to 7.3 +/- 0.3 during period 2, but returned to the control value (4.8 +/- 0.2) during period 3. Six of the 20 patients continued to need aluminum hydroxide during period 3 for satisfactory control of hyperphosphatemia. Calcium carbonate successfully lowered serum phosphorus levels and raised serum calcium levels in the majority of our patients, thereby confirming that this agent may be a satisfactory substitute for traditional phosphate binders that contain aluminum. The possibility that long-term treatment could cause such side effects as metastatic calcification will require further investigation.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aluminum Hydroxide / adverse effects
  • Calcium / blood
  • Calcium Carbonate / therapeutic use*
  • Female
  • Humans
  • Hyperparathyroidism / prevention & control
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / complications
  • Male
  • Middle Aged
  • Osteomalacia / prevention & control
  • Phosphates / blood*
  • Renal Dialysis


  • Phosphates
  • Aluminum Hydroxide
  • Calcium Carbonate
  • Calcium