Safety and effectiveness of lanthanum carbonate for hyperphosphatemia in chronic kidney disease (CKD) patients: a meta-analysis

Abstract

Objective: The aim of this study was to determine the efficacy and safety of lanthanum carbonate (LC) versus calcium salts, non-LC phosphate binders (PBs), sevelamer, or placebo in patients with chronic kidney disease (CKD).

Materials and methods: A literature search on PubMed, Embase, and Cochrane Library databases was conducted up to 18 June 2021. Data acquisition and quality assessment were performed by two reviewers. Meta-analysis was performed to evaluate the serum biochemical parameters, adverse events, and patient-level outcomes of LC, non-LC PBs, and sevelamer for hyperphosphatemia in patients with CKD. Heterogeneity across studies was assessed utilizing the I² statistic and Q-test, and a random effect model was selected to calculate the pooled effect size.

Results: A total of 26 randomized, controlled trials and 3 observational studies were included. Compared to the other groups, better control effect of serum phosphorus (RR = 2.68, p < 0.001), reduction in serum phosphorus (95%CI = -1.93, -0.99; p < 0.001), Ca × P (95%CI = -13.89, -2.99; p = 0.002), serum intact parathyroid hormone levels (95%CI = -181.17, -3.96, p = 0.041) were found in LC group. Besides, reduced risk of various adverse effects, such as hypotension, abdominal pain, diarrhea, dyspepsia, and a score of coronary artery calcification were identified with LC in comparison to calcium salt, non-LC PBs, or placebo group. Significantly lower risk in mortality with LC treatment vs. non-LC PBs was observed, while no significant difference was identified between LC and calcium salt groups.

Conclusion: LC might be an alternative treatment for hyperphosphatemia in patients with CKD considering its comprehensive curative effect.

Keywords: Chronic kidney disease; efficacy; hyperphosphatemia; lanthanum carbonate; safety.

Figure 1.

Flow diagram of the study selection process.

Figure 2.

Quality assessments of the included randomized controlled trial (RCT) articles. (A) Risk of bias graph; (B) risk of bias summary for all RCT studies.

Figure 3.

Pooled results for the serum biochemical parameters of LC treatment versus calcium salts, non-LC PBs, sevelamer, and placebo in patients with chronic kidney disease (CKD). (A) serum phosphorus control; (B) serum phosphorus; (C) Ca × P levels; (D) serum calcium; (E): serum intact parathyroid hormone; (F) serum alkaline phosphatase.

Figure 4.

Pooled results for the major adverse events of LC treatment versus calcium salts, non-LC PBs, sevelamer, and placebo in CKD patients. (A) treatment-related adverse events; (B) discontinuation due to adverse events; (C) coronary artery calcification score; (D) hypotension.

Figure 5.

Pooled results for the patient-level outcomes of LC treatment versus calcium salts, non-LC PBs, sevelamer, and placebo in CKD patients. (A) mortality; (B) gastrointestinal adverse events; (C) hypercalcemia.