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Efficacy and safety of lanthanum carbonate versus calcium-based phosphate binders in patients with chronic kidney disease: a systematic review and meta-analysis

  • Nephrology – Original Paper
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Abstract

Purpose

We conducted this review to assess the relative efficacy and safety of lanthanum carbonate versus calcium-based phosphate binders in chronic kidney disease.

Methods

We systematically searched PubMed, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials and Chinese Biological Medical Database for randomized controlled trials comparing lanthanum carbonate with calcium-based phosphate binders in adult patients with chronic kidney disease. Study quality was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of intervention. Meta-analysis was conducted by reviewer manager software, version 5.3.

Results

Eleven trials with 1,501 participants were included. Lanthanum carbonate appeared to be associated with a significant reduction in progression of vascular calcification and a beneficial effect on bone outcomes without aluminum-like toxicity. Lanthanum carbonate achieved similar proportions of phosphate-controlled patients (RR 0.63, 95 % CI 0.27–1.44) with lower incidence of hypercalcemia (RR 0.13, 95 % CI 0.05–0.35) in comparison with calcium-based phosphate binders. Lanthanum carbonate was associated with significantly lower serum calcium, similar serum Ca × P product and higher serum iPTH compared with calcium salts in patients with chronic kidney disease.

Conclusion

Lanthanum carbonate could delay the progression of vascular calcification and benefit chronic kidney disease patients on bone outcomes. Lanthanum carbonate could achieve similar proportion of phosphate-controlled patients as calcium-based phosphate binders with lower incidence of hypercalcemia.

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References

  1. Levey AS, Coresh J (2012) Chronic kidney disease. Lancet 379(9811):165–180. doi:10.1016/S0140-6736(11)60178-5

    Article  PubMed  Google Scholar 

  2. Bhan I, Thadhani R (2009) Vascular calcification and ESRD: a hard target. Clin J Am Soc Nephrol 4(Suppl 1):S102–S105. doi:10.2215/CJN.04800709

    Article  PubMed  Google Scholar 

  3. Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G, Kidney Disease: Improving Global O (2006) Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int 69(11):1945–1953. doi:10.1038/sj.ki.5000414

    Article  CAS  PubMed  Google Scholar 

  4. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol : JASN 15(8):2208–2218. doi:10.1097/01.ASN.0000133041.27682.A2

    Article  CAS  PubMed  Google Scholar 

  5. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, Young EW, Akizawa T, Akiba T, Pisoni RL, Robinson BM, Port FK (2008) Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 52(3):519–530. doi:10.1053/j.ajkd.2008.03.020

    Article  CAS  PubMed  Google Scholar 

  6. Ohya M, Otani H, Kimura K, Saika Y, Fujii R, Yukawa S, Shigematsu T (2011) Vascular calcification estimated by aortic calcification area index is a significant predictive parameter of cardiovascular mortality in hemodialysis patients. Clin Exp Nephrol 15(6):877–883. doi:10.1007/s10157-011-0517-y

    Article  CAS  PubMed  Google Scholar 

  7. Damment SJ, Pennick M (2008) Clinical pharmacokinetics of the phosphate binder lanthanum carbonate. Clin Pharmacokinet 47(9):553–563

    Article  CAS  PubMed  Google Scholar 

  8. Hutchison AJ, Barnett ME, Krause R, Kwan JT, Siami GA, Group SPDLS (2008) Long-term efficacy and safety profile of lanthanum carbonate: results for up to 6 years of treatment. Nephron Clin Pract 110(1):c15–c23. doi:10.1159/000149239

    Article  Google Scholar 

  9. Shigematsu T, Lanthanum Carbonate Research G (2008) Lanthanum carbonate effectively controls serum phosphate without affecting serum calcium levels in patients undergoing hemodialysis. Ther Apher Dial 12(1):55–61. doi:10.1111/j.1744-9987.2007.00541.x

    Article  CAS  PubMed  Google Scholar 

  10. Freemont AJ, Hoyland JA, Denton J, SPDSG Lanthanum Carbonate (2005) The effects of lanthanum carbonate and calcium carbonate on bone abnormalities in patients with end-stage renal disease. Clin Nephrol 64(6):428–437

    CAS  PubMed  Google Scholar 

  11. Hutchison AJ, Maes B, Vanwalleghem J, Asmus G, Mohamed E, Schmieder R, Backs W, Jamar R, Vosskuhler A (2005) Efficacy, tolerability, and safety of lanthanum carbonate in hyperphosphatemia: a 6-month, randomized, comparative trial versus calcium carbonate. Nephron Clin Pract 100(1):c8–c19

    Article  CAS  PubMed  Google Scholar 

  12. Lee YK, Choi HY, Shin SK, Lee HY (2013) Effect of lanthanum carbonate on phosphate control in continuous ambulatory peritoneal dialysis patients in Korea: a randomized prospective study. Clin Nephrol 79(2):136–142. doi:10.5414/cn107362

    Article  CAS  PubMed  Google Scholar 

  13. Ohtake T, Kobayashi S, Oka M, Furuya R, Iwagami M, Tsutsumi D, Mochida Y, Maesato K, Ishioka K, Moriya H, Hidaka S (2013) Lanthanum carbonate delays progression of coronary artery calcification compared with calcium-based phosphate binders in patients on hemodialysis: a pilot study. J Cardiovasc Pharmacol Ther 18(5):439–446

    Article  CAS  PubMed  Google Scholar 

  14. Scaria PT, Gangadhar R, Pisharody R (2009) Effect of lanthanum carbonate and calcium acetate in the treatment of hyperphosphatemia in patients of chronic kidney disease. Indian J Pharmacol 41(4):187–191. doi:10.4103/0253-7613.56074

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Shigematsu T, Sakai T, Kono T, Kimura Y, Takuma Y, Tsuruta Y, Mori Y, Taki M, Moriishi M, Minakuchi J, Obayashi S, Miyake S, Emoto H, Furuhashi M, Tsujimoto Y, Arisaka H, Ishizaki M, Shimoyama H, Kim S, Hirose S, Kurosawa A, Matsui N, Nakazawa R, Watanabe T, Kabaya T, Tanaka Y, Takahashi T, Ozawa T, Nakamura K, Nishioka M, Higashi H, Koga N (2008) Multicenter prospective randomized, double-blind comparative study between lanthanum carbonate and calcium carbonate as phosphate binders in Japanese hemodialysis, patients with hyperphosphatemia. Clin Nephrol 70(5):404–410

    Article  CAS  PubMed  Google Scholar 

  16. Soriano S, Ojeda R, Rodriguez M, Almaden Y, Rodriguez M, Martin-Malo A, Aljama P (2013) The effect of phosphate binders, calcium and lanthanum carbonate on FGF23 levels in chronic kidney disease patients. Clin Nephrol 80(1):17–22. doi:10.5414/cn107764

    Article  CAS  PubMed  Google Scholar 

  17. Spasovski GB, Sikole A, Gelev S, Masin-Spasovska J, Freemont T, Webster I, Gill M, Jones C, De Broe ME, D’Haese PC (2006) Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up. Nephrol Dial Transplant 21(8):2217–2224. doi:10.1093/ndt/gfl146

    Article  CAS  PubMed  Google Scholar 

  18. Toida T, Fukudome K, Fujimoto S, Yamada K, Sato Y, Chiyotanda S, Kitamura K (2012) Effect of lanthanum carbonate vs. calcium carbonate on serum calcium in hemodialysis patients: a crossover study. Clin Nephrol 78(3):216–223

    Article  CAS  PubMed  Google Scholar 

  19. Toussaint ND, Lau KK, Polkinghorne KR, Kerr PG (2011) Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis: a pilot randomized controlled trial. Nephrology 16(3):290–298

    Article  CAS  PubMed  Google Scholar 

  20. Wada K, Wada Y (2014) Evaluation of aortic calcification with lanthanum carbonate vs. calcium-based phosphate binders in maintenance hemodialysis patients with type 2 diabetes mellitus: an open-label randomized controlled trial. Ther Apher Dial. doi:10.1111/1744-9987.12153

  21. Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, Lok CE, Fitchett D, Tsuyuki RT (2013) Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 382(9900):1268–1277. doi:10.1016/S0140-6736(13)60897-1

    Article  CAS  PubMed  Google Scholar 

  22. Navaneethan SD, Palmer SC, Craig JC, Elder GJ, Strippoli GFM (2009) Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis 54(4):619–637

  23. Zhang C, Wen J, Li Z, Fan J (2013) Efficacy and safety of lanthanum carbonate on chronic kidney disease–mineral and bone disorder in dialysis patients: a systematic review. BMC Nephrol 14(1):226. doi:10.1186/1471-2369-14-226

    Article  PubMed Central  PubMed  Google Scholar 

  24. Guo H, Zhang X, Tang S, Zhang S (2013) Effects and safety of lanthanum carbonate in end stage renal disease patients with hyperphosphatemia: a meta-analysis—system review of lanthanum carbonate. Ren Fail 35(10):1455–1464. doi:10.3109/0886022X.2013.828365

    Article  CAS  PubMed  Google Scholar 

  25. National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–S201

    Google Scholar 

  26. Brennan A, Akehurst R, Davis S, Sakai H, Abbott V (2007) The cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in patients with end-stage renal disease. Value Health 10(1):32–41. doi:10.1111/j.1524-4733.2006.00142.x

    Article  PubMed  Google Scholar 

  27. Goto S, Komaba H, Moriwaki K, Fujimori A, Shibuya K, Nishioka M, Kim JI, Yoshiya K, Shin J, Hasegawa H, Taniguchi M, Fujii H, Nishi S, Kamae I, Fukagawa M (2011) Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in Japan. Clin J Am Soc Nephrol 6(6):1375–1384. doi:10.2215/CJN.08841010

    Article  PubMed Central  PubMed  Google Scholar 

  28. Park H, Rascati KL, Keith MS, Hodgkins P, Smyth M, Goldsmith D, Akehurst R (2011) Cost-effectiveness of lanthanum carbonate versus sevelamer hydrochloride for the treatment of hyperphosphatemia in patients with end-stage renal disease: a US payer perspective. Value Health 14(8):1002–1009. doi:10.1016/j.jval.2011.05.043

    Article  PubMed  Google Scholar 

  29. Vegter S, Tolley K, Keith MS, Postma MJ (2011) Cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in chronic kidney disease before and during dialysis. Value Health 14(6):852–858. doi:10.1016/j.jval.2011.05.005

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the librarians of Shandong Provincial Hospital Library for contributions in search strategies and full-text retrieval.

Conflict of interest

The authors declare that they have no conflict of interest and there is no funding related to the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China

    Chun-Juan Zhai

  2. Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, Shandong, China

    Xiao-Wei Yang, Jing Sun & Rong Wang

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  1. Chun-Juan Zhai
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Correspondence to Rong Wang.

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Zhai, CJ., Yang, XW., Sun, J. et al. Efficacy and safety of lanthanum carbonate versus calcium-based phosphate binders in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 47, 527–535 (2015). https://doi.org/10.1007/s11255-014-0876-x

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