What is the role of sodium cellulose phosphate (Calcibind) in the treatment of hypercalciuria?

Updated: Apr 23, 2019
  • Author: Stephen W Leslie, MD, FACS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Sodium cellulose phosphate (Calcibind) is an extremely effective intestinal calcium-binding agent. This agent removes about 85% of the available intestinal calcium from the digestive tract and prevents its absorption. Sodium cellulose phosphate is about 11% sodium and has a calcium-binding capacity of 1.8 mmol of calcium per gram of cellulose phosphate. In the digestive tract, the sodium ion is exchanged for calcium, which is then excreted bound to the cellulose in the stool.

When sodium cellulose phosphate is used as a therapy, supplemental magnesium and dietary oxalate restriction are recommended, because the cellulose phosphate binds magnesium as well as calcium and results in a magnesium deficiency if supplemental magnesium is not supplied.

The need for the dietary oxalate restriction (primarily of tea, cola, coffee, chocolate, nuts, and green, leafy vegetables) is due to the lack of available intestinal calcium that the cellulose therapy creates. With so much intestinal calcium bound to the cellulose, intestinal oxalate-binding sites are severely lacking. This leaves an excess of free, unbound intestinal oxalate available for absorption, which then increases oxaluria.

Unfortunately, sodium cellulose phosphate causes a reduction in absorbed calcium, which makes it useful against hypercalciuria but may cause a negative calcium balance and subsequent reduction in bone density.

The drug may nonetheless have a role in the diagnosis of hypercalciuria if used in a brief therapeutic trial and it may be useful in selected cases of absorptive hypercalciuria type I when other therapies are ineffective. The benefits of its use must be judged sufficient to justify the risks. Other treatments, such as thiazides and bisphosphonates, can be used to prevent unnecessary bone demineralization and limit the dosage of cellulose required, minimizing the adverse effects and complications associated with sodium cellulose phosphate.


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