In a male diabetic with Stage 5 CKD and a PO4 of 2, corrected Calcium of 2.38 and a raised PTH who is already sticking to a low phosphate diet, is it safe to give a calcium containing phosphate binder, or should they be started on a non-calcium containing phosphate binder?
As you may know, calcium-based phosphate binders have never been studied in a placebo-controlled study that demonstrates safety, nor superiority in the management of hyperphosphatemia. Having said that, such a patient as you described, by the standard of care in Canada (and likely elsewhere) would routinely be on calcium binders. Some might cap the total amount at 1,500 mg per day of elemental calcium, others would not worry about the limit. There could be an argument made to use non-calcium based binders in all cases. Though, more conservative views would use non-calcium based binders only in the presence of elevated plasma calcium (not the case here) or if a large dose of daily calcium is exceeded.