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Randomized Controlled Trial
. 2023 Feb 13;38(2):344-351.
doi: 10.1093/ndt/gfac043.

Effect of lanthanum carbonate on serum calciprotein particles in patients with stage 3-4 CKD-results from a placebo-controlled randomized trial

Mark K Tiong  1   2 , Edward R Smith  1   2 , Elaine M Pascoe  3 , Grahame J Elder  4   5   6   7 , Nicole M Lioufas  1   2   8 , Eugenia Pedagogos  8 , Carmel M Hawley  3   9   10 , Andrea Valks  3 , Stephen G Holt  1   2   11   12 , Tim D Hewitson  1   2 , Nigel D Toussaint  1   2
Affiliations
Randomized Controlled Trial

Effect of lanthanum carbonate on serum calciprotein particles in patients with stage 3-4 CKD-results from a placebo-controlled randomized trial

Mark K Tiong et al. Nephrol Dial Transplant. .

Abstract

Background: Calciprotein particles (CPP) are colloidal aggregates of calcium phosphate and the mineral-binding protein fetuin-A, and are potential mediators of cardiovascular disease in chronic kidney disease (CKD). Emerging evidence suggests non-calcium-containing phosphate binders may reduce serum CPP in patients with kidney failure who require dialysis; however, it is unclear whether similar interventions are effective in patients with earlier stages of CKD.

Methods: The IMpact of Phosphate Reduction On Vascular End-points in CKD (IMPROVE-CKD) was a multi-centre, placebo-controlled, randomized trial of lanthanum carbonate on cardiovascular markers in 278 participants with stage 3b/4 CKD. In this pre-specified exploratory analysis, primary (CPP-I) and secondary CPP (CPP-II) were measured in a sub-cohort of participants over 96 weeks. Treatment groups were compared using linear mixed-effects models and the relationship between serum CPP and pulse wave velocity (PWV) and abdominal aortic calcification (AAC) was examined.

Results: A total of 253 participants had CPP data for baseline and at least one follow-up timepoint and were included in this analysis. The mean age was 62.4 ± 12.6 years, 32.0% were female and the mean estimated glomerular filtration rate (eGFR) was 26.6 ± 8.3 mL/min/1.73 m2. Baseline median serum CPP-I was 14.9 × 104 particles/mL [interquartile range (IQR) 4.6-49.3] and median CPP-II was 3.3 × 103 particles/mL (IQR 1.4-5.4). There was no significant difference between treatment groups at 96 weeks in CPP-I [22.8% (95% confidence interval -39.2, 36.4), P = 0.65] or CPP-II [-18.3% (95% confidence interval -40.0, 11.2), P = 0.20] compared with a placebo. Serum CPP were not correlated with baseline PWV or AAC, or with the progression of either marker.

Conclusions: Lanthanum carbonate was not associated with a reduction of CPP at 96 weeks when compared with a placebo in a CKD cohort.

Keywords: calciprotein particles; cardiovascular disease; chronic kidney disease; mineral metabolism; phosphate binders.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Serum primary (CPP-I) and secondary (CPP-II) calciprotein particles over 96 weeks by treatment group (geometric mean and 95% confidence interval).
See this image and copyright information in PMC

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