Reducing high phosphate levels in patients with chronic renal failure undergoing dialysis: a 4-week, dose-finding, open-label study with lanthanum carbonate

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2004-07, Vol.19 (7), p.1902-1906
• Main Authors: Hutchison, Alastair J., Speake, Mary, Al-Baaj, Fouad
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; chronic renal failure; dialysis; dose titration; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; hyperphosphataemia; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Lanthanum - administration & dosage; lanthanum carbonate; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; phosphate; Phosphates - blood; Renal Dialysis; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Titrimetry
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh282

Background. The majority of patients with end-stage renal disease on dialysis are hyperphosphataemic. Lanthanum carbonate has been shown to be a highly effective phosphate binder in pre-clinical studies. A 4-week, open-label, dose-titration trial was conducted to assess the ability of lanthanum carbonate to control phosphate levels in patients with chronic renal failure. Methods. This preliminary study was of 6 weeks duration: 2 weeks of washout followed by 4 weeks of dose titration. Patients (n = 59) were titrated on the basis of weekly serum phosphate levels from a daily dose of 375 mg lanthanum carbonate to a maximum dose of 2250 mg. Patients were maintained on the dose that controlled serum phosphate to between 1.30 and 1.80 mmol/l (4.03–5.58 mg/dl). Serum phosphate levels represented the main efficacy assessment. Safety was also evaluated. Results. Most patients were successfully titrated to 1500 and 2250 mg lanthanum/day (mean dose at end of titration: 1278 mg). At completion of the study 70% of patients achieved a serum phosphate of ≤1.80 mmol/l. The use of lanthanum carbonate in patients undergoing continuous ambulatory peritoneal dialysis or haemodialysis was generally well tolerated. Conclusions. Lanthanum carbonate, a new non-aluminium, non-calcium phosphate binder, effectively reduces serum phosphate levels. Results of longer-term efficacy and safety studies are awaited with interest.