In an uncontrolled study, 22 dialysis patients (46±14 years, duration of dialysis 20±11 months) were treated with CaCO3over a period of up to 3 years to lower their serum phosphate. The use of 4.5–9 g CaCO3daily over a period of 9 months led to a reduction of mean serum phosphate from 2.51 to 1.51 mmol/1 in 77of patients, with a simultaneous increase in mean calcium concentration from 2.23 to 2.47 mmol/1, and an improved control of secondary hyperparathyroidism by reduction in mPTH from 1552 to 1032 pg/ml and in APH activity from 6.25 to 4.55μmol/s/1.In long-term CaCO3treatment of up to 3 years, however, a constant effective phosphate reduction could not be achieved. There was a progression (77) of pre-existing microcalcification and a new appearance (42) of microcalcification in vessels and soft-tissue areas of the hand. The percentage of patients with soft-tissue calcification increased from 43 to 67during a treatment period of 3 years.We conclude that CaCO3alone is not suitable on a long-term basis for phosphate reduction in dialysis pati
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