Lanthanum carbonate for hyperphosphatemia in patients on peritoneal dialysis

Abstract

Background: The efficacy of the phosphate binder lanthanum carbonate has been demonstrated for hemodialysis patients, but no studies have focused on patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We evaluated whether lanthanum carbonate could control phosphate levels in patients on CAPD. ♢

Methods: In this 48-week open-label prospective study, 28 patients on CAPD with a phosphate level of 6 mg/dL or greater were given lanthanum carbonate titrated from 750 mg to 2250 mg daily to achieve a target serum phosphate level of less than 6 mg/dL. The primary efficacy endpoint was reduction of serum phosphate to less than 6 mg/dL. Serum levels of calcium and parathyroid hormone were also evaluated, as were the Ca×P product and adverse effects. ♢

Results: From week 4 to the end of the study at week 48, we observed a significant reduction of serum phosphate to 5.25 ± 0.97 mg/dL from 6.88 ± 1.06 mg/dL at study start (p < 0.01). At the end of the study, 78.6% of participants had achieved the target of less than 6 mg/dL. Because no change of serum calcium occurred, the Ca×P product declined significantly during the study. Intact parathyroid hormone declined gradually over the study period, but the change had not reached significance at the end of the study (p = 0.11). The mean final dose of lanthanum carbonate was 946 mg daily. The only adverse effect reported was mild nausea in 1 patient. ♢

Conclusions: Lanthanum carbonate is an effective phosphate binder that can control serum phosphate and Ca×P product in CAPD patients with hyperphosphatemia. Lanthanum carbonate was well tolerated in our population.

Keywords: CAPD; Ca×P product; Lanthanum carbonate; continuous ambulatory peritoneal dialysis; hyperphosphatemia; parathyroid hormone.

Figure 1

— Study enrollment.

Figure 2

— Serum phosphate level throughout the study (mean ± standard deviation). The mean phosphate level declined significantly and progressively during the study.

Figure 3

— The percentage of patients with serum phosphate less than 6 mg/dL increased throughout the study period.

Figure 4

— Serum calcium (mean ± standard deviation) was unchanged throughout the study.

Figure 5

— Ca×P product (mean ± standard deviation) declined significantly and progressively throughout the study.

Figure 6

— Serum intact parathyroid hormone [PTH (mean ± standard deviation)] declined gradually throughout the study, but had not reached significance at the end of the study.