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Ying M, Shi J, Ling Y, Shi T, Liao L, Cao L. Long-term safety of lanthanum carbonate in the real word: a 19-year disproportionality analysis from the FDA Adverse Event Reporting System. Expert Opin Drug Saf 2024:1-8. [PMID: 38602862 DOI: 10.1080/14740338.2024.2343014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Lanthanum carbonate is widely used to manage serum phosphate and calcium levels in end-stage kidney disease (ESKD) patients, yet comprehensive long-term safety data are lacking. This study leverages the FDA Adverse Event Reporting System (FAERS) to assess the extended safety profile of lanthanum carbonate. RESEARCH DESIGN AND METHODS We analyzed FAERS data (2004-2022) to study the association between lanthanum carbonate and adverse events (AEs). Using MedDRA v25.0, we identified risk signals through System Organ Classes (SOCs) and Preferred Terms (PTs). Disproportionality analyzes quantified lanthanum carbonate-associated AE signals. RESULTS Among 3,284 reports, 2,466 were primary suspected AEs linked to lanthanum carbonate. Males reported AEs more frequently than females. Patients aged over 64 represented the majority. Median onset time for lanthanum carbonate-related AEs was 146 days. Gastrointestinal disorders were prevalent. We identified 16 new signals, including stress, abnormal hepatic function, cholelithiasis, bile duct stone, gastric cancer, and adenocarcinoma gastric. Stress was notable, particularly in male patients over 65 and those with lower weight. CONCLUSIONS This study affirms lanthanum carbonate's long-term safety for reducing elevated blood phosphorus levels. While gastrointestinal disorders were common, attention must focus on emerging AEs, particularly stress, especially in elderly patients.
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Affiliation(s)
- Mengjia Ying
- Department of Pharmacy, People's Hospital of Longhua, Shenzhen, Guangdong, China
| | - Jian Shi
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yahao Ling
- Department of Pharmacy, People's Hospital of Longhua, Shenzhen, Guangdong, China
| | - Tao Shi
- Department of Pharmacy, People's Hospital of Longhua, Shenzhen, Guangdong, China
| | - Lele Liao
- Department of Pharmacy, People's Hospital of Longhua, Shenzhen, Guangdong, China
| | - Linhui Cao
- Department of Traditional Chinese Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Nain P, Nayak N, Maj MC, Singh RK, Kaur J, Jeong Y, Maity S, Nath R, Hilgers RH, Nauhria S, Nauhria S. Efficacy of Lanthanum Carbonate and Sevelamer Carbonate as Phosphate Binders in Chronic Kidney Disease-A Comparative Clinical Study. PHARMACY 2023; 11:pharmacy11010027. [PMID: 36827665 PMCID: PMC9960578 DOI: 10.3390/pharmacy11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Hyperphosphatemia is correlated with an increased rate of mortality and morbidity due to cardiovascular diseases in chronic kidney disease (CKD) patients. It can be improved by restricting dietary intake of phosphate and oral phosphate binders, such as lanthanum carbonate and sevelamer carbonate. (2) Objective: To evaluate the clinical efficacy of sevelamer carbonate in comparison to lanthanum carbonate as phosphate binders for the treatment of hyperphosphatemia in CKD patients. (3) Methods: A randomized control comparative clinical study was conducted for one year on 150 CKD patients associated with hyperphosphatemia, divided into two groups, i.e., Group 1 (n = 75) treated with sevelamer carbonate 800 mg thrice daily and Group 2 (n = 75) treated with lanthanum carbonate 500 mg thrice daily. The patients were assessed at the time of enrollment in the study, after three months and after six months from baseline for different parameters, i.e., complete blood count, liver function tests, renal function tests, electrolytes, and serum phosphate level. (4) Results: 150 CKD patients aged 51-60 participated in the study. The mean age of patients was 54 ± 4.6 years, and males (55.71%) were more common than females (44.29%). Hypertension was the common comorbidity in both groups with chronic kidney disease. After six months of treatment, the mean serum phosphate level was significantly decreased from 8.31 ± 0.09 mg/dL to 5.11 ± 0.18 (38%) in Group 1 and from 8.79 ± 0.28 mg/dl to 4.02 ± 0.12 (54%; p < 0.05) in Group 2, respectively. In both groups, no significant difference was found in other parameters such as parathyroid hormone, calcium, uric acid, LFT, RFT, CBC, etc. (5) Conclusion: Lanthanum carbonate is more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia as compared to sevelamer carbonate.
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Affiliation(s)
- Parminder Nain
- CT Institute of Pharmaceutical Sciences, Jalandhar 144020, Punjab, India
| | - Narendra Nayak
- Department of Microbiology, St. Matthew’s University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Mary C. Maj
- Department of Biochemistry, St. George’s University School of Medicine, St. George’s, Grenada
| | - Rohit Kumar Singh
- MM College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, Haryana, India
| | - Jaspreet Kaur
- CT Institute of Pharmaceutical Sciences, Jalandhar 144020, Punjab, India
| | - Yujin Jeong
- Medical Student Research Institute, Department of Clinical Medicine, American University of Antigua, St. John’s, Antigua and Barbuda
| | - Sabyasachi Maity
- Department of Physiology, Neuroscience and Behavioral Sciences, St. George’s University School of Medicine, St. George’s, Grenada
| | - Reetuparna Nath
- Department of Education Service, St. George’s University, St. George’s, Grenada
| | - Robert H. Hilgers
- Department of Pharmacology, St. Matthew’s University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester LE1 7RH, UK
| | - Samal Nauhria
- Department of Pathology, St. Matthew’s University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
- Correspondence:
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Hashimoto A, Gao J, Kanome Y, Ogawa Y, Nakatsu M, Kohno M, Fukui K. Evaluation of cerium oxide as a phosphate binder using 5/6 nephrectomy model rat. BMC Nephrol 2022; 23:277. [PMID: 35941569 PMCID: PMC9358871 DOI: 10.1186/s12882-022-02904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of chronic kidney disease (CKD) patients continues to increase worldwide. CKD patients need to take phosphate binders to manage serum phosphorus concentrations. Currently, several types of phosphate binder, including lanthanum carbonate, are used. However, they each have disadvantages. METHODS In this study, we evaluated cerium oxide as a new phosphate binder in vitro and in vivo. First, cerium oxide was mixed with phosphoric acid at pH 2.5 or 7.0, and residual phosphoric acid was measured by absorption photometry using colorimetric reagent. Second, cerium oxide was fed to 5/6 nephrectomy model rats (5/6Nx), a well-known renal damage model. All rats were measured food intake, water intake, feces volume, and urine volume, and collected serum and urine were analyzed for biochemical markers. RESULTS Cerium oxide can adsorb phosphate at acidic and neutral pH, while lanthanum carbonate, which is a one of popular phosphate binder, does not dissolve at neutral pH. Cerium oxide-treatment reduced serum phosphate concentrations of 5/6Nx rats without an increase in serum alanine transaminase levels that would indicate hepatotoxicity, and cerium oxide-treatment maintained serum creatinine and blood urea nitrogen levels, while those of normal 5/6Nx rats increased slightly. CONCLUSIONS These results suggest that cerium oxide can be a potential phosphate binder. Decreased body weight gain and increased water intake and urine volume in 5/6Nx rats were thought to be an effect of nephrectomy because these changes did not occur in sham operation rats. Additional investigations are needed to evaluate the longer-term safety and possible accumulation of cerium oxide in the body.
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Affiliation(s)
- Akiko Hashimoto
- applause Company Limited, Biko building 4F, Shinkawa 2-24-2, Chuo-ku, Tokyo, 104-0033, Japan.,Molecular Cell Biology Laboratory, Department of Systems Engineering and Science, Graduate School of Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan
| | - Jiaqi Gao
- Molecular Cell Biology Laboratory, Department of Systems Engineering and Science, Graduate School of Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan
| | - Yuki Kanome
- Molecular Cell Biology Laboratory, Department of Bioscience and Engineering, College of System Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan
| | - Yukihiro Ogawa
- applause Company Limited, Biko building 4F, Shinkawa 2-24-2, Chuo-ku, Tokyo, 104-0033, Japan
| | - Masaharu Nakatsu
- applause Company Limited, Biko building 4F, Shinkawa 2-24-2, Chuo-ku, Tokyo, 104-0033, Japan
| | - Masahiro Kohno
- SIT Research Institute, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan
| | - Koji Fukui
- Molecular Cell Biology Laboratory, Department of Systems Engineering and Science, Graduate School of Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan. .,Molecular Cell Biology Laboratory, Department of Bioscience and Engineering, College of System Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Minuma-ku, Saitama, 337-8570, Japan.
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4
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Wasilewska A, Murray RA, Sundberg A, Uddin S, Achenbach H, Shavkin A, Szabó T, Vergani A, Umeh O. An open-label phase 2 trial to assess the efficacy, safety and pharmacokinetics of lanthanum carbonate in hyperphosphatemic children and adolescents with chronic kidney disease undergoing dialysis. BMC Nephrol 2022; 23:84. [PMID: 35236302 PMCID: PMC8892701 DOI: 10.1186/s12882-022-02688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the efficacy, tolerability and pharmacokinetics (PK) of lanthanum carbonate (LC) in hyperphosphatemic children and adolescents with chronic kidney disease (CKD) undergoing dialysis. METHODS This was a three-part, multicenter, open-label study of LC (oral powder formulation) in patients 10 to < 18 years old with CKD undergoing dialysis. In part 1, the single-dose PK of LC (500 mg, ≤12 years old; 1000 mg, > 12 years old) were summarized. In part 2, patients received calcium carbonate (CC [chewable tablet formulation]) (1500-6500 mg [total daily dose]) followed by LC (powder formulation) (1500-3000 mg [total daily dose]), or LC only (1500-3000 mg [total daily dose]), each for 8 weeks. During part 3, patients received LC (1500-3000 mg [total daily dose]) for up to 6 months. The primary efficacy endpoint was the proportion of LC-treated patients achieving serum phosphorus control after 8 weeks during parts 2 and/or 3, defined as: ≤1.94 mmol/L, < 12 years old; ≤1.78 mmol/L, ≥12 years old. Secondary efficacy endpoints included: the proportion of patients who achieved serum phosphorus control after 8 weeks of treatment with CC followed by 8 weeks of treatment with LC (with a washout period between treatments). The safety of LC and CC was also evaluated. RESULTS In part 1, 20 patients received a single dose of LC. In part 2, 53 and 51 patients were treated with CC and LC for 8 weeks, respectively. During part 3, 42 patients received LC for up to 6 months. Most patients were white and male. For the primary efficacy endpoint, 50% (17/34) of patients who received LC for 8 weeks during parts 2 and/or 3 achieved serum phosphorus control. After 8 weeks of treatment with CC, 58.8% of patients achieved serum phosphorus control; after a subsequent washout period and 8 weeks of treatment with LC, 70.6% of patients achieved serum phosphorus control. Tmax and t1/2 occurred within 3-8 h and ~ 19 h, respectively; however, variability was observed. LC and CC were generally well tolerated. CONCLUSIONS These data support the use of LC to manage hyperphosphatemia in pediatric patients with CKD undergoing dialysis. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01696279; EudraCT identifier: 2012-000171-17. Date of registration: 01/10/2012.
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Affiliation(s)
- Anna Wasilewska
- Department of Pediatrics and Nephrology, Faculty of Medicine, Medical University of Bialystok, University Children's Clinical Hospital of Bialystok, Waszyngtona, Bialystok, Poland.
| | - Rose Ann Murray
- Shire Human Genetic Therapies, Inc., a Takeda Company, Cambridge, MA, USA
| | - Aimee Sundberg
- Shire Human Genetic Therapies, Inc., a Takeda Company, Cambridge, MA, USA
| | - Sharif Uddin
- Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA
| | | | - Aleksey Shavkin
- Saint Petersburg State Budgetary Healthcare Institution, Children's City Multidisciplinary Clinical Specialized Center of High Medical Technologies, Saint Petersburg, Russia
| | - Tamás Szabó
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Vergani
- Shire Human Genetic Therapies, Inc., a Takeda Company, Cambridge, MA, USA
| | - Obi Umeh
- Shire Human Genetic Therapies, Inc., a Takeda Company, Cambridge, MA, USA
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Vekeman J, Torres J, David CE, Van de Perre E, Wissing KM, Letavernier E, Bazin D, Daudon M, Pozdzik A, Tielens F. In Search of an Efficient Complexing Agent for Oxalates and Phosphates: A Quantum Chemical Study. NANOMATERIALS 2021; 11:nano11071763. [PMID: 34361148 PMCID: PMC8308151 DOI: 10.3390/nano11071763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022]
Abstract
Limiting gastrointestinal oxalate absorption is a promising approach to reduce urinary oxalate excretion in patients with idiopathic and enteric hyperoxaluria. Phosphate binders, that inhibit gastrointestinal absorption of dietary phosphate by the formation of easily excretable insoluble complexes, are commonly used as a treatment for hyperphosphatemia in patients with end-stage renal disease. Several of these commercially available phosphate binders also have affinity for oxalate. In this work, a series of metallic cations (Li+, Na+, Mg2+, Ca2+, Fe2+, Cu2+, Zn2+, Al3+, Fe3+ and La3+) is investigated on their binding affinity to phosphate and oxalate on one side and anionic species that could be used to administer the cationic species to the body on the other, e.g., acetate, carbonate, chloride, citrate, formate, hydroxide and sulphate. Through quantum chemical calculations, the aim is to understand the competition between the different complexes and propose possible new and more efficient phosphate and oxalate binders.
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Affiliation(s)
- Jelle Vekeman
- General Chemistry (ALGC), Materials Modelling Group, Vrije Universiteit Brussels, 1050 Brussels, Belgium
- Correspondence: (J.V.); (J.T.); (F.T.)
| | - Javier Torres
- Grupo de Química Computacional y Teórica (QCT-USFQ), Departamento de Ingeniería Química, Universidad San Francisco de Quito (USFQ), Diego de Robles y Vía Interoceánica, Quito 17-1200-841, Ecuador
- Instituto de Simulación Computacional (ISC-USFQ), Departamento de Ingeniería Química, Universidad San Francisco de Quito (USFQ), Diego de Robles y Vía Interoceánica, Quito 17-1200-841, Ecuador
- Correspondence: (J.V.); (J.T.); (F.T.)
| | - Cristina Eugenia David
- Kidney Stone Clinic, Nephrology Department, Centre Hospitalier Universitaire, Brugmann Hospital, 1020 Brussels, Belgium; (C.E.D.); (A.P.)
- Faculty of Medicine, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Els Van de Perre
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (E.V.d.P.); (K.M.W.)
| | - Karl Martin Wissing
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (E.V.d.P.); (K.M.W.)
| | - Emmanuel Letavernier
- Sorbonne Universités-UPMC Univ. Paris 06, UMR S 1155, 75020 Paris, France; (E.L.); (M.D.)
- INSERM, UMR S 1155, 75020 Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Dominique Bazin
- Institut de Chimie Physique, UMR CNRS 8000, Université Paris Saclay, Bâtiment 350, CEDEX, 91405 Orsay, France;
- Laboratoire de Physique des Solides, UMR CNRS 8502, Université Paris-Saclay, Bâtiment 510, CEDEX, 91405 Orsay, France
| | - Michel Daudon
- Sorbonne Universités-UPMC Univ. Paris 06, UMR S 1155, 75020 Paris, France; (E.L.); (M.D.)
- INSERM, UMR S 1155, 75020 Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Agnieszka Pozdzik
- Kidney Stone Clinic, Nephrology Department, Centre Hospitalier Universitaire, Brugmann Hospital, 1020 Brussels, Belgium; (C.E.D.); (A.P.)
- Faculty of Medicine, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Frederik Tielens
- General Chemistry (ALGC), Materials Modelling Group, Vrije Universiteit Brussels, 1050 Brussels, Belgium
- Correspondence: (J.V.); (J.T.); (F.T.)
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6
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Tsuchiya K, Akihisa T. The Importance of Phosphate Control in Chronic Kidney Disease. Nutrients 2021; 13:nu13051670. [PMID: 34069053 PMCID: PMC8156430 DOI: 10.3390/nu13051670] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
A series of problems including osteopathy, abnormal serum data, and vascular calcification associated with chronic kidney disease (CKD) are now collectively called CKD-mineral bone disease (CKD-MBD). The pathophysiology of CKD-MBD is becoming clear with the emerging of αKlotho, originally identified as a progeria-causing protein, and bone-derived phosphaturic fibroblast growth factor 23 (FGF23) as associated factors. Meanwhile, compared with calcium and parathyroid hormone, which have long been linked with CKD-MBD, phosphate is now attracting more attention because of its association with complications and outcomes. Incidentally, as the pivotal roles of FGF23 and αKlotho in phosphate metabolism have been unveiled, how phosphate metabolism and hyperphosphatemia are involved in CKD-MBD and how they can be clinically treated have become of great interest. Thus, the aim of this review is reconsider CKD-MBD from the viewpoint of phosphorus, its involvement in the pathophysiology, causing complications, therapeutic approach based on the clinical evidence, and clarifying the importance of phosphorus management.
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Affiliation(s)
- Ken Tsuchiya
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- Correspondence:
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
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7
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Di Y, Wasan EK, Cawthray J, Syeda J, Ali M, Cooper DML, Al-Dissi A, Ashjaee N, Cheng W, Johnston J, Weekes DM, Kostelnik TI, Orvig C, Wasan KM. Evaluation of La(XT), a novel lanthanide compound, in an OVX rat model of osteoporosis. Bone Rep 2021; 14:100753. [PMID: 33665236 PMCID: PMC7905442 DOI: 10.1016/j.bonr.2021.100753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy and toxicity of a novel lanthanum compound, La(XT), in an ovariectomized (OVX) rat model of osteoporosis. Methods Twenty-four ovariectomized female Sprague Dawley rats were divided into 3 groups receiving a research diet with/without treatment compounds (alendronate: 3 mg/kg; La(XT) 100 mg/kg) for three months. At the time of sacrifice, the kidney, liver, brain, lung and spleen were collected for histological examination. The trabecular bone structure of the tibiae was evaluated using micro-CT and a three-point metaphyseal mechanical test was used to evaluate bone failure load and stiffness. Results No significant differences were noted in plasma levels of calcium, phosphorus, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) between the La(XT) treatment compared to the non-treated OVX group. Alendronate-treated animals (positive control) showed higher BV/TV, Tb.N and lower Tb.Th and Tb.Sp when compared to the non-treated OVX group. Mechanical analysis indicated that stiffness was higher in the alendronate (32.88%, p = 0.04) when compared to the non-treated OVX group. Failure load did not differ among the groups. Conclusions No kidney or liver toxicities of La(XT) treatments were found during the three-month study. The absence of liver and kidney toxicity with drug treatment for 3 months, as well as the increased trabecular bone stiffness are encouraging for the pursuit of further studies with La(XT) for a longer duration of time.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BMD, bone mineral density
- BV/TV, bone volume fraction
- CRF, chronic renal failure
- Ca2+, calcium
- Cr, creatinine
- HAP, hydroxyapatite
- La(XT)
- La3+, lanthanum
- Lanthanum
- OVX
- OVX, ovariectomized
- Osteoporosis
- SD, Sprague Dawley
- Tb.N, trabecular number
- Tb.Sp, trabecular separation
- Tb.Th, trabecular thickness
- Toxicity
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Affiliation(s)
- Yunyun Di
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Ellen K Wasan
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Jacqueline Cawthray
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Jaweria Syeda
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Munawar Ali
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - David M L Cooper
- Department of Anatomy Physiology and Pharmacology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Ahmad Al-Dissi
- Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada
| | - Nima Ashjaee
- College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - Wubin Cheng
- College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - James Johnston
- College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - David M Weekes
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6T 1Z1, Canada
| | - Thomas I Kostelnik
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6T 1Z1, Canada
| | - Chris Orvig
- Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6T 1Z1, Canada
| | - Kishor M Wasan
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.,Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Wieszczycka K, Staszak K, Woźniak-Budych MJ, Jurga S. Lanthanides and tissue engineering strategies for bone regeneration. Coord Chem Rev 2019. [DOI: 10.1016/j.ccr.2019.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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9
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D'Haese PC, Douglas G, Verhulst A, Neven E, Behets GJ, Vervaet BA, Finsterle K, Lürling M, Spears B. Human health risk associated with the management of phosphorus in freshwaters using lanthanum and aluminium. CHEMOSPHERE 2019; 220:286-299. [PMID: 30590295 DOI: 10.1016/j.chemosphere.2018.12.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 12/11/2018] [Indexed: 05/22/2023]
Abstract
The use of geo-engineering materials to manage phosphorus in lakes has increased in recent years with aluminium and lanthanum based materials being most commonly applied. Hence the potential impact of the use of these compounds on human health is receiving growing interest. This review seeks to understand, evaluate and compare potential unintended consequences on human health and ecotoxicological risks associated with the use of lanthanum- and aluminium-based materials to modify chemical and ecological conditions in water bodies. In addition to their therapeutic use for the reduction of intestinal phosphate absorption in patients with impaired renal function, the phosphate binding capacity of aluminium and lanthanum also led to the development of materials used for water treatment. Although lanthanum and aluminium share physicochemical similarities and have many common applications, their uptake and kinetics within the human body and living organisms importantly differ from each other which is reflected in a different toxicity profile. Whilst a causal role in the development of neurological pathologies, skeletal lesions, hematopoietic disorders and respiratory effects has unequivocally been demonstrated with increased exposure to aluminium, studies until now have failed to find such a clear association after exposure to lanthanum although caution is warranted. Our review indicates that lanthanum and aluminium have a distinctly different profile with respect to their potential effects on human health. Regular monitoring of both aluminium and lanthanum concentrations in lanthanum-/aluminium-treated water by the responsible authorities is recommended to avoid acute accidental or chronic low level accumulation.
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Affiliation(s)
- Patrick C D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium.
| | | | - Anja Verhulst
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - Ellen Neven
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - Geert J Behets
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | | | - Karin Finsterle
- Abteilung Limnologie, Institut Dr. Nowak, Mayenbrook 1, 28870 Ottersberg, Germany
| | - Miquel Lürling
- Department of Environmental Sciences, Wageningen University, Wageningen, the Netherlands
| | - Bryan Spears
- Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, UK
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Hutchison A, Whelton A, Thadhani R, Achenbach H, Vergani A, Wu J, Hall G. Long-Term Mortality and Bone Safety in Patients with End-Stage Renal Disease Receiving Lanthanum Carbonate. Nephron Clin Pract 2018; 140:265-274. [PMID: 30352437 DOI: 10.1159/000492603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS This post-marketing observational study assessed the long-term safety of lanthanum carbonate (LaC) in US patients with end-stage renal disease (NCT00567723). METHODS Patients (≥18 years old) undergoing dialysis, who had Medicare as their primary healthcare payer, and records in the United States Renal Data System were followed-up for 5 years. Patients who had received LaC for at least 12 consecutive weeks formed the exposed cohort. During the same time period, patients who had undergone dialysis for at least 12 consecutive weeks and had been treated with any other phosphate binder formed the primary comparator cohort. A historical cohort was also evaluated. Primary outcomes were all-cause mortality, and time to and incidence of first bone-fracture event requiring hospitalization. Secondary outcomes were time to first occurrence of and incidence of specific gastrointestinal (GI) disease, liver disease, malignancy, and major infectious episode requiring hospitalization. -Results: 2,026 and 8,094 patients were included in the exposed and primary comparator cohorts, respectively. A Cox proportional hazards model showed that patients receiving LaC were not at increased risk of all-cause mortality (adjusted hazard ratio 0.94; 95% CI 0.88-1.01; p = 0.078), bone fractures (0.86; 0.71-1.05; p = 0.130), specific GI disease (0.86; 0.76-0.97; p = 0.015), liver disease (0.88; 0.70-1.09; p = 0.236), malignancy (0.85; 0.54-1.34; p = 0.496), or major infectious episodes (0.87; 0.80-0.94; p < 0.001) requiring hospitalization compared with primary comparator patients. CONCLUSIONS LaC was not associated with increased risk of mortality, bone fractures, or any secondary outcome.
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Affiliation(s)
- Alastair Hutchison
- Renal Dialysis Unit, Manchester Royal Infirmary and Manchester Academic Health Science Centre, Manchester, United
| | - Andrew Whelton
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ravi Thadhani
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Andrea Vergani
- Clinical Research and Development, Shire, Lexington, Massachusetts, USA
| | - Jingyang Wu
- Biostatistics, Shire, Lexington, Massachusetts, USA
| | - Gillian Hall
- Gillian Hall Epidemiology Ltd., London, United Kingdom
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11
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Yabuki K, Haratake J, Tsuda Y, Shiba E, Harada H, Yorita K, Uchihashi K, Matsuyama A, Hirata K, Hisaoka M. Lanthanum-Induced Mucosal Alterations in the Stomach (Lanthanum Gastropathy): a Comparative Study Using an Animal Model. Biol Trace Elem Res 2018; 185:36-47. [PMID: 29302869 DOI: 10.1007/s12011-017-1235-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022]
Abstract
Lanthanum (La) carbonate (LC) is one of the most potent phosphate binders that prevents the elevation of serum phosphate levels in patients with end-stage renal diseases undergoing dialysis. LC binds strongly to dietary phosphate and forms insoluble complexes that pass through the gastrointestinal tract. La deposition in patients treated with LC is a recently documented finding particularly observed in gastric mucosa. We herein describe the detailed gastric mucosal lesions in 45 LC-treated patients and address the potential underlying pathologic mechanism using oral LC administration in rats. Microscopically, La deposition, as shown by subepithelial collections of plump eosinophilic histiocytes or small foreign body granulomas containing coarse granular or amorphous inclusion bodies, was found in the gastric mucosa of 44 (97.8%) of the 45 dialysis patients in the study cohort, which was most frequently associated with foveolar hyperplasia (37.8%). Using oral administration of rats with 1000 mg/day LC for 2 or more weeks, La deposition was consistently detectable in the gastric mucosa but not in other organs examined. In addition, various histologic alterations such as glandular atrophy, stromal fibrosis, proliferation of mucous neck cells, intestinal metaplasia, squamous cell papilloma, erosion, and ulcer were demonstrated in the rat model. Thus, orally administered LC can induce mucosal injury, designated here as La gastropathy, which may alter the local environment and result in La deposition in the gastric mucosa, thereby potentially inducing abnormal cell proliferation or neoplastic lesions.
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Affiliation(s)
- Kei Yabuki
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Joji Haratake
- Division of Pathology, Saiseikai Yahata General Hospital, Kitakyushu, Japan
| | - Yojiro Tsuda
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Hiroshi Harada
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | | | - Atsuji Matsuyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Keiji Hirata
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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12
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Rationale, design, and characteristics of a trial to evaluate the new phosphate iron-based binder sucroferric oxyhydroxide in dialysis patients with the goal of advancing the practice of E.B.M. (EPISODE). Clin Exp Nephrol 2018. [DOI: 10.1007/s10157-018-1547-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Fujii H, Kono K, Nakai K, Goto S, Nishii T, Kono A, Nishi S. Effects of Lanthanum Carbonate on Coronary Artery Calcification and Cardiac Abnormalities After Initiating Hemodialysis. Calcif Tissue Int 2018; 102:310-320. [PMID: 29058057 DOI: 10.1007/s00223-017-0347-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/13/2017] [Indexed: 12/14/2022]
Abstract
It is known that calcium-containing phosphate binders are more closely associated with the progression of vascular calcification than non-calcium-containing phosphate binders. In this study, we investigated the effect of the non-calcium-containing phosphate binder, lanthanum carbonate on the progression of coronary artery calcification and cardiovascular abnormalities compared to that of calcium-containing phosphate binder in chronic kidney disease patients during the early period after initiating hemodialysis. This was a randomized open-label study in which patients were divided into the calcium carbonate or lanthanum carbonate group. We evaluated blood samples, coronary artery calcification using high-resolution computed tomography, and cardiac abnormalities using echocardiography prior to and after initiating hemodialysis. Cardiac dimension and systolic function were significantly improved in the lanthanum carbonate group compared to those in the calcium carbonate group. Although statistically significant differences were not observed in all the patients, only among patients with moderate coronary artery calcification, the changes in coronary artery calcification score at 18 months were significantly smaller in the lanthanum carbonate group than those in the calcium carbonate group. The percent change in coronary artery calcification at 18 months was significantly correlated with the serum fibroblast growth factor 23 levels at 18 months (r = 0.245, P < 0.05). This significant correlation was particularly strong in patients with moderate coronary artery calcification (r = 0.593, P < 0.001). Our study suggests that lanthanum carbonate ameliorates cardiac abnormalities, and may slow coronary artery calcification development in patients with moderate coronary artery calcification, during the early period following hemodialysis initiation.
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Affiliation(s)
- Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kentaro Nakai
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tatsuya Nishii
- Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Kono
- Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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14
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Waajen G, van Oosterhout F, Lürling M. Bio-accumulation of lanthanum from lanthanum modified bentonite treatments in lake restoration. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 230:911-918. [PMID: 28738303 DOI: 10.1016/j.envpol.2017.07.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
Lanthanum (La) modified bentonite (LMB) is one of the available mitigating agents used for the reduction of the phosphorus (P) recycling in eutrophic lakes. The potential toxicity of the La from LMB to aquatic organisms is a matter of concern. In this study the accumulation of La was investigated in the macrophyte Elodea nuttallii, in chironomid larvae and in several fish species during periods up to five years following in situ LMB applications. The application of LMB increased the La concentration of exposed plants and animals. During the first growing season following LMB applications, the La content of E. nuttallii increased 78 fold (3.98-310.68 μg La g-1 DW) to 127 fold (2.46-311.44 μg La g-1). During the second growing season following application, the La content decreased but was still raised compared to plants that had not been exposed. The La content of chironomids was doubled in the two years following LMB application, although the increase was not significant. Raised La concentrations in fish liver, bone, muscle and skin were observed two and five years following to LMB application. Liver tissues showed the highest La increase, ranging from 6 fold (0.046-0.285 μg La g-1 DW) to ∼20 fold (0.080-1.886 μg La g-1, and 0.122-2.109 μg La g-1) two years following application and from 6 fold (0.046-0.262 μg La g-1) to 13 fold (0.013-0.167 μg La g-1) after five years in pelagic and littoral fish. The La content of the liver from Anguilla anguilla (eel) had increased 94 fold (0.034-3.176 μg La g-1) two years and 133 fold (0.034-4.538 μg La g-1) five years following LMB application. No acute and chronic effects of La accumulation were observed and human health risks are considered negligible. We advocate the long-term study of effects of La accumulation following future LMB applications.
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Affiliation(s)
- G Waajen
- Water Authority Brabantse Delta, P.O. Box 5520, 4801 DZ Breda, The Netherlands.
| | - F van Oosterhout
- Aquatic Ecology & Water Quality Management Group, Department of Environmental Sciences, Wageningen University, P.O. Box 47, 6700 AA Wageningen, The Netherlands.
| | - M Lürling
- Aquatic Ecology & Water Quality Management Group, Department of Environmental Sciences, Wageningen University, P.O. Box 47, 6700 AA Wageningen, The Netherlands; Department of Aquatic Ecology, Netherlands Institute of Ecology (NIOO-KNAW), P.O. Box 50, 6700 AB Wageningen, The Netherlands.
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15
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Hutchison AJ, Wilson RJ, Garafola S, Copley JB. Lanthanum carbonate: safety data after 10 years. Nephrology (Carlton) 2017; 21:987-994. [PMID: 27479781 PMCID: PMC5129531 DOI: 10.1111/nep.12864] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 12/19/2022]
Abstract
Despite 10 years of post-marketing safety monitoring of the phosphate binder lanthanum carbonate, concerns about aluminium-like accumulation and toxicity persist. Here, we present a concise overview of the safety profile of lanthanum carbonate and interim results from a 5-year observational database study (SPD405-404; ClinicalTrials.gov identifier: NCT00567723). The pharmacokinetic paradigms of lanthanum and aluminium are different in that lanthanum is minimally absorbed and eliminated via the hepatobiliary pathway, whereas aluminium shows appreciable absorption and is eliminated by the kidneys. Randomised prospective studies of paired bone biopsies revealed no evidence of accumulation or toxicity in patients treated with lanthanum carbonate. Patients treated with lanthanum carbonate for up to 6 years showed no clinically relevant changes in liver enzyme or bilirubin levels. Lanthanum does not cross the intact blood-brain barrier. The most common adverse effects are mild/moderate nausea, diarrhoea and flatulence. An interim Kaplan-Meier analysis of SPD405-404 data from the United States Renal Data System revealed that the median 5-year survival was 51.6 months (95% CI: 49.1, 54.2) in patients who received lanthanum carbonate (test group), 48.9 months (95% CI: 47.3, 50.5) in patients treated with other phosphate binders (concomitant therapy control group) and 40.3 months (95% CI: 38.9, 41.5) in patients before the availability of lanthanum carbonate (historical control group). Bone fracture rates were 5.9%, 6.7% and 6.4%, respectively. After more than 850 000 person-years of worldwide patient exposure, there is no evidence that lanthanum carbonate is associated with adverse safety outcomes in patients with end-stage renal disease.
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16
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Shigematsu T, Negi S, Ohya M. Long-term observational study in Japanese hemodialysis patients who completed a 3-year clinical study of lanthanum carbonate. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0040-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Yabuki K, Shiba E, Harada H, Uchihashi K, Matsuyama A, Haratake J, Hisaoka M. Lanthanum deposition in the gastrointestinal mucosa and regional lymph nodes in dialysis patients: Analysis of surgically excised specimens and review of the literature. Pathol Res Pract 2016; 212:919-926. [PMID: 27515549 DOI: 10.1016/j.prp.2016.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/22/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023]
Abstract
Lanthanum carbonate (LC) is one of the most potent phosphate binders currently used to reduce serum phosphate levels in dialysis patients with end-stage renal disease (ESRD). LC forms insoluble complexes with dietary phosphate that pass through the gastrointestinal (GI) tract with little absorption. GI lesions due to lanthanum deposition in biopsy specimens or those in endoscopic submucosal dissection (ESD) in dialysis patients have been recently identified. Here, we describe more detailed histopathological findings in the gastroduodenal mucosa and regional lymph nodes in three patients with gastric cancer. Three patients with ESRD, two elderly women and one man, underwent dialysis and were treated with LC for 3-36 months. The patients underwent laparoscopic distal gastrectomy and lymph node dissection due to gastric cancer. Many subepithelial histiocyte aggregates or small foreign body granulomas, which contained gray or brown pigments or crystal-like structures, were mostly present in non-neoplastic areas of the upper GI. Lanthanum accumulation was noted in the duodenal mucosa and the antral and body mucosae of the gastric lesser curvature. Lanthanum was also deposited in the regional lymph nodes of the three patients. Electron microscopy with energy dispersive X-ray spectroscopy confirmed lanthanum and phosphorus deposits in histiocytes. Long-term prognosis of patients and the excretion or the metabolic pathway of accumulated lanthanum remain unclear.
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Affiliation(s)
- Kei Yabuki
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Hiroshi Harada
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Kazuyoshi Uchihashi
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Atsuji Matsuyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | - Joji Haratake
- Division of Pathology, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi, Yahatanhigashi-ku, Kitakyushu 805-0050, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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18
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Pai AB, Jang SM, Wegrzyn N. Iron-based phosphate binders--a new element in management of hyperphosphatemia. Expert Opin Drug Metab Toxicol 2015; 12:115-27. [PMID: 26572591 DOI: 10.1517/17425255.2016.1110573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of serum phosphorus in patients with chronic kidney disease remains a significant clinical challenge. A pivotal component of the clinical approach to maintaining serum phosphorus concentrations towards the normal range is the use of phosphate binding agents in addition to comprehensive dietary counseling. The available agents work similarly by capitalizing on a cation within the agent to bind negatively charged phosphorus, forming an insoluble complex and reducing ingested phosphorus absorption. Despite several effective options for phosphate binder therapies, patient adherence remains an issue, mainly due to adverse effect profiles and large daily pill burdens. AREAS COVERED Two new iron-based phosphate binder therapies have recently become available in the United States, sucroferric oxyhydroxide and ferric citrate. These agents have both been shown to effectively reduce serum phosphorus comparably to widely used calcium-based binders and sevelamer salts. EXPERT OPINION The two new iron-based binders differ substantially with regard to phosphate binding chemistry and iron absorption profiles. Their place in therapy is still evolving and the impact of pill burden, gastrointestinal adverse effect profiles, potential cost reduction of anemia therapies and physiologic effects of long-term iron exposure need to be further evaluated.
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Affiliation(s)
- Amy Barton Pai
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
| | - Soo Min Jang
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
| | - Nicole Wegrzyn
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
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Kendrick J, Chonchol M. Novel Therapeutic Options for the Treatment of Mineral Metabolism Abnormalities in End Stage Renal Disease. Semin Dial 2015; 28:610-9. [PMID: 26278462 DOI: 10.1111/sdi.12412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abnormalities in mineral metabolism are a universal complication in dialysis patients and are associated with an increased risk of cardiovascular disease and mortality. Hyperphosphatemia, increased fibroblast growth factor 23 levels and secondary hyperparathyroidism are all strongly associated with adverse outcomes in end stage renal disease (ESRD) and most treatment strategies target these parameters. Over the past few years, new therapies have emerged for the treatment of abnormalities of mineral metabolism in ESRD and many are promising. This article will review these new therapeutic options including the potential advantages and disadvantages compared to existing therapies.
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Affiliation(s)
- Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado.,Denver Health Medical Center, Denver, Colorado
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
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20
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Rodríguez M, Rodríguez-Ortiz ME. Advances in pharmacotherapy for secondary hyperparathyroidism. Expert Opin Pharmacother 2015; 16:1703-16. [DOI: 10.1517/14656566.2015.1061994] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Contemporary management of phosphorus retention in chronic kidney disease: a review. Clin Exp Nephrol 2015; 19:985-99. [DOI: 10.1007/s10157-015-1126-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/14/2015] [Indexed: 12/18/2022]
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22
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Van Buren PN, Lewis JB, Dwyer JP, Greene T, Middleton J, Sika M, Umanath K, Abraham JD, Arfeen SS, Bowline IG, Chernin G, Fadem SZ, Goral S, Koury M, Sinsakul MV, Weiner DE. The Phosphate Binder Ferric Citrate and Mineral Metabolism and Inflammatory Markers in Maintenance Dialysis Patients: Results From Prespecified Analyses of a Randomized Clinical Trial. Am J Kidney Dis 2015; 66:479-88. [PMID: 25958079 DOI: 10.1053/j.ajkd.2015.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/03/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Phosphate binders are the cornerstone of hyperphosphatemia management in dialysis patients. Ferric citrate is an iron-based oral phosphate binder that effectively lowers serum phosphorus levels. STUDY DESIGN 52-week, open-label, phase 3, randomized, controlled trial for safety-profile assessment. SETTING & PARTICIPANTS Maintenance dialysis patients with serum phosphorus levels ≥6.0 mg/dL after washout of prior phosphate binders. INTERVENTION 2:1 randomization to ferric citrate or active control (sevelamer carbonate and/or calcium acetate). OUTCOMES Changes in mineral bone disease, protein-energy wasting/inflammation, and occurrence of adverse events after 1 year. MEASUREMENTS Serum calcium, intact parathyroid hormone, phosphorus, aluminum, white blood cell count, percentage of lymphocytes, serum urea nitrogen, and bicarbonate. RESULTS There were 292 participants randomly assigned to ferric citrate, and 149, to active control. Groups were well matched. For mean changes from baseline, phosphorus levels decreased similarly in the ferric citrate and active control groups (-2.04±1.99 [SD] vs -2.18±2.25 mg/dL, respectively; P=0.9); serum calcium levels increased similarly in the ferric citrate and active control groups (0.22±0.90 vs 0.31±0.95 mg/dL; P=0.2). Hypercalcemia occurred in 4 participants receiving calcium acetate. Parathyroid hormone levels decreased similarly in the ferric citrate and active control groups (-167.1±399.8 vs -152.7±392.1 pg/mL; P=0.8). Serum albumin, bicarbonate, serum urea nitrogen, white blood cell count and percentage of lymphocytes, and aluminum values were similar between ferric citrate and active control. Total and low-density lipoprotein cholesterol levels were lower in participants receiving sevelamer than those receiving ferric citrate and calcium acetate. Fewer participants randomly assigned to ferric citrate had serious adverse events compared with active control. LIMITATIONS Open-label study, few peritoneal dialysis patients. CONCLUSIONS Ferric citrate was associated with similar phosphorus control compared to active control, with similar effects on markers of bone and mineral metabolism in dialysis patients. There was no evidence of protein-energy wasting/inflammation or aluminum toxicity, and fewer participants randomly assigned to ferric citrate had serious adverse events. Ferric citrate is an effective phosphate binder with a safety profile comparable to sevelamer and calcium acetate.
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Affiliation(s)
| | | | | | - Tom Greene
- University of Utah Medical Center, Salt Lake City, UT
| | | | | | | | | | | | - Isai G Bowline
- Wake Forest University Medical Center, Winston-Salem, NC
| | | | | | - Simin Goral
- University of Pennsylvania Medical Center, Philadelphia, PA
| | - Mark Koury
- Vanderbilt University Medical Center, Nashville, TN
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Miyazaki A, Matsuo A, Iida A, Nishino N, Maeda K, Matsumoto Y, Orui S. [Pharmacological profile and clinical findings of a new phosphate binder, ferric citrate hydrate (Riona® Tablets)]. Nihon Yakurigaku Zasshi 2014; 144:294-304. [PMID: 25492366 DOI: 10.1254/fpj.144.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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24
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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. Int Urol Nephrol 2014; 47:527-35. [DOI: 10.1007/s11255-014-0876-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/01/2014] [Indexed: 12/29/2022]
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25
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Idée JM, Fretellier N, Robic C, Corot C. The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: A critical update. Crit Rev Toxicol 2014; 44:895-913. [PMID: 25257840 DOI: 10.3109/10408444.2014.955568] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jean-Marc Idée
- Guerbet, Research & Innovation Division , Aulnay-sous-Bois , France
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26
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Ando R, Yama S, Ohnishi T, Iwamoto S, Kimura H, Chida Y, Ishida Y, Yamada K, Inagaki Y, Takayama M, Tachibana K, Kikuchi K, Inoue A, Ohtsuka M. Multicenter Study on the Long-Term (3-Year) Efficacy of Lanthanum Carbonate in Dialysis Patients. Ther Apher Dial 2014; 18 Suppl 1:2-8. [DOI: 10.1111/1744-9987.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ryoichi Ando
- Department of Nephrology; Musashino Red Cross Hospital; Tokyo Japan
| | - Satomi Yama
- Department of Nephrology; Musashino Red Cross Hospital; Tokyo Japan
| | - Tsuyoshi Ohnishi
- Department of Nephrology; Musashino Red Cross Hospital; Tokyo Japan
| | - Shunsuke Iwamoto
- Department of Nephrology; Musashino Red Cross Hospital; Tokyo Japan
| | - Hitoshi Kimura
- Department of Nephrology; Musashino Red Cross Hospital; Tokyo Japan
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Hyodo T, Kawakami J, Mikami N, Wakai H, Ishii D, Yoshida K, Iwamura M, Hida M, Kurata Y. Increase in the Dosage Amount of Vitamin D3 Preparations by Switching From Calcium Carbonate to Lanthanum Carbonate. Ther Apher Dial 2014; 18 Suppl 1:14-7. [DOI: 10.1111/1744-9987.12198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Toru Hyodo
- Department of Urology and Blood Purification; Kuratakai Eijin Clinic; Hiratsuka Japan
- Department of Urology; Kitasato University School of Medicine; Sagamihara Japan
- Cambodia-Japan Friendship Blood Purification Center; Sen Sok International University School of Medicine; Phnom Penh Cambodia
| | - Junko Kawakami
- Department of Food and Nutrition; Sagami Women's Junior College; Sagamihara Japan
| | - Noriko Mikami
- Department of Nutrition; Kuratakai Eijin Clinic; Kurata Hospital; Hiratsuka Japan
| | - Haruki Wakai
- Department of Urology; Kitasato University School of Medicine; Sagamihara Japan
- Shinagawa Garden Clinic; Tokyo Japan
| | - Daisuke Ishii
- Department of Urology; Kitasato University School of Medicine; Sagamihara Japan
| | - Kazunari Yoshida
- Department of Urology; Kitasato University School of Medicine; Sagamihara Japan
| | - Masatsugu Iwamura
- Department of Urology; Kitasato University School of Medicine; Sagamihara Japan
| | - Miho Hida
- Department of Nephrology; Kuratakai Kurata Hospital; Hiratsuka Japan
| | - Yasuhisa Kurata
- Department of Nephrology; Kuratakai Kurata Hospital; Hiratsuka Japan
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Takashima T, Sanai T, Miyazono M, Fukuda M, Kishi T, Nonaka Y, Yoshizaki M, Sato S, Ikeda Y. A comparison of the long-term effects of lanthanum carbonate and calcium carbonate on the course of chronic renal failure in rats with adriamycin-induced nephropathy. PLoS One 2014; 9:e97859. [PMID: 24846276 PMCID: PMC4028261 DOI: 10.1371/journal.pone.0097859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/24/2014] [Indexed: 12/04/2022] Open
Abstract
Lanthanum carbonate (LA) is an effective phosphate binder. Previous study showed the phosphate-binding potency of LA was twice that of calcium carbonate (CA). No study in which LA and CA were given at an equivalent phosphate-binding potency to rats or humans with chronic renal failure for a long period has been reported to date. The objective of this study was to compare the phosphate level in serum and urine and suppression of renal deterioration during long-term LA and CA treatment when they were given at an equivalent phosphate-binding potency in rats with adriamycin (ADR)-induced nephropathy. Rats were divided into three groups: an untreated group (ADR group), a CA-treated (ADR-CA) group and a LA-treated (ADR-LA) group. The daily oral dose of LA was 1.0 g/kg/day and CA was 2.0 g/kg/day for 24 weeks. The serum phosphate was lower in the ADR-CA or ADR-LA group than in the ADR group and significantly lower in the ADR-CA group than in the ADR group at each point, but there were no significant differences between the ADR and ADR-LA groups. The serum phosphate was also lower in the ADR-CA group than in the ADR-LA group, and there was significant difference at week 8. The urinary phosphate was significantly lower in the ADR-CA group than in the ADR or ADR-LA group at each point. The urinary phosphate was also lower in the ADR-LA group than in the ADR group at each point, and significant difference at week 8. There were no significant differences in the serum creatinine or blood urea nitrogen among the three groups. In conclusion, this study indicated the phosphate-binding potency of LA isn’t twice as strong as CA, and neither LA nor CA suppressed the progression of chronic renal failure in the serum creatinine and blood urea nitrogen, compared to the untreated group.
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Affiliation(s)
- Tsuyoshi Takashima
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
- * E-mail:
| | - Toru Sanai
- Department of Nephrology, Fukumitsu Hospital, Fukuoka, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
| | - Makoto Fukuda
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomoya Kishi
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasunori Nonaka
- Department of Nephrology, Ureshino Medical Center, Ureshino, Japan
| | - Mai Yoshizaki
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
| | - Sae Sato
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuji Ikeda
- Department of Nephrology, Faculty of Medicine, Saga University, Saga, Japan
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Yokoyama K, Akiba T, Fukagawa M, Nakayama M, Sawada K, Kumagai Y, Chertow GM, Hirakata H. Long-term safety and efficacy of a novel iron-containing phosphate binder, JTT-751, in patients receiving hemodialysis. J Ren Nutr 2014; 24:261-7. [PMID: 24836401 DOI: 10.1053/j.jrn.2014.03.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/06/2014] [Accepted: 03/15/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE JTT-751 is a novel phosphate binder containing ferric citrate as the active ingredient. This study investigated long-term safety and efficacy of JTT-751 for hyperphosphatemia in patients receiving hemodialysis. DESIGN AND METHODS This was 52-week, phase 3, multicenter, open-label, dose titration, long-term study. All patients were receiving thrice-weekly hemodialysis for ≥3 months before the initiation of the study. JTT-751 was given at titrated doses between 1.5 and 6.0 g/day. MAIN OUTCOME MEASURES Safety endpoints were adverse events and adverse drug reactions. Efficacy outcomes were the change in serum phosphate, corrected serum calcium, and intact parathyroid hormone. Changes in ferritin, transferrin saturation, and doses of erythropoiesis-stimulating agents (ESAs) and intravenous iron formulations were additional outcomes. RESULTS One hundred and eighty patients were included in the trial. Dose-titrated JTT-751 decreased mean serum phosphate after administration and satisfactorily maintained serum phosphate concentrations throughout the entire duration of the 52-week trial. Mean serum phosphate concentrations were kept lower than 5.5 mg/dL from weeks 5 to 52. The most common adverse events were gastrointestinal disorders, which were mild to moderate in intensity. Serum ferritin concentrations rose to a peak around week 28 and stabilized thereafter. The mean intravenous iron dose decreased from 57.3 mg/4 weeks (weeks 0-12) to 3.6 mg/4 weeks (weeks 28-52); weekly ESA dose declined by 25% over the same time frame, while mean hemoglobin concentrations remained stable. CONCLUSION JTT-751 1.5-6.0 g/day controls serum phosphorus concentrations and reduces the need for ESAs and intravenous iron in patients receiving hemodialysis.
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Affiliation(s)
- Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Takashi Akiba
- Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Masaaki Nakayama
- Department of Nephrology, Hypertension, Diabetology, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Sawada
- Department of Hematology, Nephrology, and Rheumatology, Akita University, Akita, Japan
| | - Yuji Kumagai
- Kitasato University East Hospital Clinical Trial Center, Sagamihara, Japan
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Locatelli F, Del Vecchio L, Violo L, Pontoriero G. Phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a comparison of safety profiles. Expert Opin Drug Saf 2014; 13:551-61. [PMID: 24702470 DOI: 10.1517/14740338.2014.907791] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hyperphosphatemia is common in the late stages of chronic kidney disease (CKD) and is associated with elevated parathormone levels, abnormal bone mineralization, extraosseous calcification and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control phosphorus levels. Although effective at lowering serum phosphorus, they all have safety issues that need to be considered when selecting which one to use. AREAS COVERED This paper reviews the use of phosphate binders in patients with CKD on dialysis, with a focus on safety and tolerability. In addition to the more established agents, a new resin-based phosphate binder, colestilan, is discussed. EXPERT OPINION Optimal phosphate control is still an unmet need in CKD. Nonetheless, we now have an extending range of phosphate binders available. Aluminium has potentially serious toxic risks. Calcium-based binders are still very useful but can lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, but there is insufficient evidence about possible long-term effects of tissue deposition. The resin-based binders, colestilan and sevelamer, appear to have profiles that would lead to less vascular calcification, and the main adverse events seen with these agents are gastrointestinal effects.
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Affiliation(s)
- Francesco Locatelli
- Alessandro Manzoni Hospital, Department of Nephrology Dialysis , Via dell'Eremo 9, 23900 Lecco , Italy +39 0341 489850 ; +39 0341 489860 ;
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Wang S, Anum EA, Ramakrishnan K, Alfieri T, Braunhofer P, Newsome B. Reasons for phosphate binder discontinuation vary by binder type. J Ren Nutr 2014; 24:105-9. [PMID: 24462496 DOI: 10.1053/j.jrn.2013.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/05/2013] [Accepted: 11/22/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Nonadherence to phosphate binder regimen is common among end-stage renal disease patients and contributes to elevated phosphorus levels. Pill burden, side effects, complex regimens, and cost all contribute to nonadherence. We retrospectively analyzed reasons for discontinuation in hemodialysis patients receiving treatment at a large U.S. dialysis organization to better understand the drivers of nonadherence for particular phosphate binders. DESIGN AND SETTING Patient electronic medical records were reviewed to identify phosphate binder prescriptions and reasons for discontinuation. Reasons for discontinuation were categorized and the percentage of patients on each type of phosphate binder was calculated within categories. SUBJECTS Medicare patients of age ≥18 years, receiving in-center hemodialysis treatment between July 1, 2009, and June 30, 2011, were included in the analysis. RESULTS We classified 30,933 patient records with a stated reason for phosphate binder discontinuation for this study. Of these records, 50.1% cited that the patient discontinued the phosphate binder but contained no additional information; "lab results" were cited for 27.4% of the reasons for discontinuation and "patient-reported side effects" for 10.8%. Although patients on lanthanum carbonate accounted for 14% of the total number reasons for discontinuation assessed, they comprised 40% of the "patient-reported side effects" category and were similarly overrepresented in 4 of the 5 subcategories. CONCLUSIONS The high percentage of patient-reported side effects resulting in discontinuation identifies an unmet need for improved phosphate binders. A disproportionate percentage of patients prescribed lanthanum carbonate reported side effects, however further work is needed to identify the relative tolerability of phosphate binders and potential explanations.
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Affiliation(s)
- Steven Wang
- DaVita Clinical Research, Minneapolis, Minnesota
| | | | | | | | - Peter Braunhofer
- Vifor Fresenius Medical Care Renal Pharma, Glattbrugg, Switzerland
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Wada K, Wada Y. 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 2014; 18:353-60. [DOI: 10.1111/1744-9987.12153] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kentaro Wada
- Division of Nephrology and Dialysis; Nippon Kokan Fukuyama Hospital; Hiroshima Japan
- Department of Internal Medicine; Central Hospital; Hiroshima Japan
| | - Yuko Wada
- Division of Nephrology and Dialysis; Nippon Kokan Fukuyama Hospital; Hiroshima Japan
- Department of Internal Medicine; Central Hospital; Hiroshima Japan
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Yokoyama K, Hirakata H, Akiba T, Fukagawa M, Nakayama M, Sawada K, Kumagai Y, Block GA. Ferric citrate hydrate for the treatment of hyperphosphatemia in nondialysis-dependent CKD. Clin J Am Soc Nephrol 2014; 9:543-52. [PMID: 24408120 DOI: 10.2215/cjn.05170513] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Ferric citrate hydrate is a novel iron-based phosphate binder being developed for hyperphosphatemia in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A phase 3, multicenter, randomized, double blind, placebo-controlled study investigated the efficacy and safety of ferric citrate hydrate in nondialysis-dependent patients with CKD. Starting in April of 2011, 90 CKD patients (eGFR=9.21±5.72 ml/min per 1.73 m(2)) with a serum phosphate≥5.0 mg/dl were randomized 2:1 to ferric citrate hydrate or placebo for 12 weeks. The primary end point was change in serum phosphate from baseline to the end of treatment. Secondary end points included the percentage of patients achieving target serum phosphate levels (2.5-4.5 mg/dl) and change in fibroblast growth factor-23 at the end of treatment. RESULTS The mean change in serum phosphate was -1.29 mg/dl (95% confidence interval, -1.63 to -0.96 mg/dl) in the ferric citrate hydrate group and 0.06 mg/dl (95% confidence interval, -0.20 to 0.31 mg/dl) in the placebo group (P<0.001 for difference between groups). The percentage of patients achieving target serum phosphate levels was 64.9% in the ferric citrate hydrate group and 6.9% in the placebo group (P<0.001). Fibroblast growth factor-23 concentrations were significantly lower in patients treated with ferric citrate hydrate versus placebo (change from baseline [median], -142.0 versus 67.0 pg/ml; P<0.001). Ferric citrate hydrate significantly increased serum iron, ferritin, and transferrin saturation compared with placebo (P=0.001 or P<0.001). Five patients discontinued active treatment because of treatment-emergent adverse events with ferric citrate hydrate treatment versus one patient with placebo. Overall, adverse drug reactions were similar in patients receiving ferric citrate hydrate or placebo, with gastrointestinal disorders occurring in 30.0% of ferric citrate hydrate patients and 26.7% of patients receiving placebo. CONCLUSION In patients with nondialysis-dependent CKD, 12-week treatment with ferric citrate hydrate resulted in significant reductions in serum phosphate and fibroblast growth factor-23 while simultaneously increasing serum iron parameters.
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Affiliation(s)
- Keitaro Yokoyama
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan;, †Japanese Red Cross, Fukuoka Hospital, Fukuoka, Japan;, ‡Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan;, §Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan;, ‖Department of Nephrology, Hypertension, Diabetology, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan;, ¶Department of Hematology, Nephrology and Rheumatology, Akita University, Akita, Japan;, *Kitasato University East Hospital Clinical Trial Center, Sagamihara, Japan, ††Denver Nephrologists, PC, Denver, Colorado
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Sonikian M, Papachristou E, Goumenos DS. Optimal use of phosphate binders in chronic kidney disease. Expert Opin Pharmacother 2013; 14:2521-32. [PMID: 24215605 DOI: 10.1517/14656566.2013.852183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Hyperphosphatemia is one of the major factors associated with the development of vascular calcification in patients with chronic kidney disease (CKD). Since phosphate is retained in such patients, pharmacological treatment and other measures are necessary to control hyperphosphatemia. Several phosphate binders (calcium salts, magnesium salts, non-calcium-based binders and aluminium) are available for the treatment of hyperphosphatemia. Nevertheless, none of the above mentioned agents has shown an overall superiority over others, while potency and side effects are quite variable among them creating difficulties in choosing the optimal drug for each patient. AREAS COVERED The authors discuss the disturbed phosphate metabolism, the available phosphate binders, as well as the general therapeutic principles of treating hyperphosphatemia in CKD patients. The literature used for this review had been retrieved from PubMed and covers a large number of original and retrospective studies as well as prospective cohort studies, meta-analyses and international clinical guidelines. EXPERT OPINION Lowering serum phosphate levels in CKD patients may potentially have a positive impact on cardiovascular morbidity and mortality. Factors that should be taken into consideration when selecting a specific drug include CKD stage, cardiovascular disease, severity of secondary hyperparathyroidism, concomitant medications, life expectancy and patient compliance. Therefore, when selecting a specific phosphate binder, individualisation is mandatory.
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Affiliation(s)
- Makrouhi Sonikian
- Sismanoglion - A. Fleming General Hospital, Department of Nephrology , 15232 Athens , Greece +0030 210 6859562 ; +0030 2610 994424 ;
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Lloret M, Ruiz-García C, DaSilva I, Furlano M, Barreiro Y, Ballarín J, Bover J. Lanthanum carbonate for the control of hyperphosphatemia in chronic renal failure patients: a new oral powder formulation - safety, efficacy, and patient adherence. Patient Prefer Adherence 2013; 7:1147-56. [PMID: 24235818 PMCID: PMC3826937 DOI: 10.2147/ppa.s31694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with very high mortality rates, mainly of cardiovascular origin. The retention of phosphate (P) and increased fibroblast growth factor-23 levels are common, even at early stages of CKD, due to disturbances in normal P homeostasis. Later, hyperphosphatemia appears, which has also been strongly associated with high mortality rates linked to P-mediated cardiovascular and procalcifying effects. Treatment guidelines for these patients continue to be poorly implemented, at least partially due to the lack of adherence to a P-restricted diet and P-binder therapy. Calcium-free P binders, such as lanthanum carbonate, have been associated with a decreased progression of vascular calcification, rendering them an important therapeutic alternative for these high cardiovascular risk CKD patients. Lanthanum carbonate has typically been available as chewable tablets, and the new presentation as an oral powder may provide a useful alternative in the therapeutic armamentarium. This powder is a tasteless, odorless, and colorless semisolid compound miscible with food. In a recent study in healthy individuals, the safety and efficacy of this novel form were evaluated, and it was concluded that it is well tolerated and pharmacodynamically equivalent to the chewable form. In the long run, individualization of preferences and treatments seems an achievable goal prior to final demonstration of improvements in hard outcomes in wide clinical trials in CKD patients.
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Affiliation(s)
- MªJesús Lloret
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - César Ruiz-García
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Iara DaSilva
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mónica Furlano
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Yaima Barreiro
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - José Ballarín
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Jordi Bover
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
- Correspondence: Jordi Bover, Nephrology Department, Fundació Puigvert, C Cartagena 340-350, 08025 Barcelona, Spain, Tel +34 93 416 97 00, Fax +34 93 416 97 30, Email
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Shinoda T, Yamasaki M, Chida Y, Takagi M, Tanaka Y, Ando R, Suzuki T, Tagawa H. Improvement of MBD parameters in dialysis patients by a switch to, and combined use of lanthanum carbonate: Josai Dialysis Forum collaborative study. Ther Apher Dial 2013; 17 Suppl 1:29-34. [PMID: 23586510 DOI: 10.1111/1744-9987.12041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Indexed: 12/23/2022]
Abstract
The effects of lanthanum carbonate on MBD parameters were investigated in 59 hemodialysis patients who were taking calcium carbonate. Lanthanum carbonate (initial dosage: 750 mg/day), as a replacement for or in combination with calcium carbonate and/or sevelamer hydrochloride, was administered for 12 months with increase/decrease of dosages. Lanthanum carbonate replaced calcium carbonate for 21 cases and was co-administered in 38 cases. It replaced sevelamer hydrochloride in 20 cases and was co-administered in 10 cases. Both the number of cases to which calcium carbonate was administered and their dosages decreased to about 70-80% 12 months after the initiation, and cases administered sevelamer decreased to about 30%. In the cases for which lanthanum carbonate was co-administered, the dosages of calcium carbonate and sevelamer slightly decreased. A significant decrease in serum calcium level was observed. In the serum phosphorus levels (P levels), significant decrease compared with the initial level was observed only at six and nine months. Intact parathyroid hormone (iPTH) level remained stable at around 230 pg/mL without significant change. The dosage of vitamin D and cinacalcet remained without significant change. The results of this trial suggest that, if dosages of vitamin D and cinacalcet are adequately controlled, a switch to lanthanum carbonate and its concomitant use are effective to control the Ca and P levels without changing iPTH levels.
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Affiliation(s)
- Toshio Shinoda
- Dialysis Center, Kawakita General Hospital, Asagaya-kita 1-7-3, Tokyo, Japan.
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Zhang C, Wen J, Li Z, Fan J. Efficacy and safety of lanthanum carbonate on chronic kidney disease-mineral and bone disorder in dialysis patients: a systematic review. BMC Nephrol 2013; 14:226. [PMID: 24134531 PMCID: PMC3853136 DOI: 10.1186/1471-2369-14-226] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 10/11/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in CKD patients, particularly in those with end-stage renal disease that requires dialysis. Lanthanum carbonate (LC) is a potent, non-aluminum, non-calcium phosphate binder. This systematic review evaluates the efficacy and safety of LC in CKD-MBD treatment for maintenance-dialysis patients. METHODS A systematic review and meta-analysis on randomized controlled trials (RCTs) and quasi-RCTs was performed to assess the efficacy and safety of LC in maintenance hemodialysis or peritoneal dialysis patients. Analysis was performed using the statistical software Review Manager 5.1. RESULTS Sixteen RCTs involving 3789 patients were identified and retained for this review. No statistical difference was found in all-cause mortality. The limited number of trials was insufficient to show the superiority of LC over other treatments in lowering vascular calcification or cardiovascular events and in improving bone morphology, bone metabolism, or bone turn-over parameters. LC decreased the serum phosphorus level and calcium × phosphate product (Ca × P) as compared to placebo. LC, calcium carbonate (CC), and sevelamer hydrochloride (SH) were comparable in terms of controlling the serum phosphorus, Ca × P product, and intact parathyroid hormone (iPTH) levels. However, LC resulted in a lower serum calcium level and a higher bone-specific alkaline phosphatase level compared with CC. LC had higher total cholesterol and low-density lipoprotein (LDL) cholesterol levels compared with SH. LC-treated patients appeared to have a higher rate of vomiting and lower risk of hypercalcemia, diarrhea, intradialytic hypotension, cramps or myalgia, and abdominal pain. Meta-analysis showed no significant difference in the incidence of other side effects. Accumulation of LC in blood and bone was below toxic levels. CONCLUSIONS LC has high efficacy in lowering serum phosphorus and iPTH levels without increasing the serum calcium. Current evidence does not show a higher rate of adverse effects for LC compared with other treatments, except for a higher incidence of vomiting. Moreover, LC accumulation in blood and bone was below toxic levels. Well-designed studies should be conducted to evaluate the long-term effects of LC.
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Affiliation(s)
- Chenglong Zhang
- Department of nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Ji Wen
- Department of nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Zi Li
- Department of nephrology, West China Hospital of Sichuan University, Chengdu, China
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Yu C, Chen B, Zhao T, Wang R, Akhtar J, Wang H, Zhang H. High phosphate feeding induced arterial medial calcification in uremic rats: Roles of Lanthanum carbonate on protecting vasculature. Life Sci 2013; 93:646-53. [DOI: 10.1016/j.lfs.2013.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/04/2013] [Accepted: 08/19/2013] [Indexed: 01/24/2023]
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Thet Z, Win AK, Pedagogos E, Beavis J, Crikis S, Nelson C. Differential effects of phosphate binders on pre-dialysis serum bicarbonate in end-stage kidney disease patients on maintenance haemodialysis. BMC Nephrol 2013; 14:205. [PMID: 24079654 PMCID: PMC3850673 DOI: 10.1186/1471-2369-14-205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 09/25/2013] [Indexed: 11/10/2022] Open
Abstract
Background Phosphate binders’ constituents have alkalotic or acidotic properties and may contribute to acid base balance in haemodialysis patients. This study aimed to investigate the differential effects of phosphate binders on pre-dialysis serum bicarbonate in End Stage Kidney Disease patients on maintenance haemodialysis. Methods Stable out-patients having satellite haemodialysis for at least 3 months were retrospectively studied for 18 months, excluding those with other medical causes for metabolic acidosis. Blood results were censored for inpatient episodes, at the time of death, renal transplant or dialysis modality change. Multivariable multilevel mixed-effects linear regression was used and five groups of phosphate binders were compared: Group A(Calcium (Ca) and/or Aluminium (Al) binders); B(Sevelamer hydrochloride (SH) alone); C(lanthanum carbonate (LC) alone); D(SH and Ca/Al), E(LC and Ca/Al). Results Of 320 patients, 292 were eligible for analysis with a mean follow-up of 15.54 (standard deviation, SD 3.98) months. Similar mean pre-dialysis serum levels of bicarbonate were observed at all 6 month-interval analyses. At 18th months, observed mean serum bicarbonate levels in mmol/L were Group B: 21.58 (SD 2.82, P<0.001), C: 23.29 (SD 2.80, P=0.02), D: 21.56 (SD 3.00, P<0.001), and E: 21.29 (SD 3.62, P=0.92) compared with Group A: 22.98 (SD 2.77). Mean serum bicarbonate was related to total SH dose in mmol/L: 22.34 (SD 2.56) for SH <2.5 g/day, 21.61 (SD 2.62) for SH 2.5-4.8 g/day, 21.04 (SD 3.31) for SH >4.8 g/day compared with 22.85 (SD 2.91) for non-users; P-trend<0.001. Conclusions Phosphate binders’ constituents may contribute to/protect against a predisposition to pre-dialysis metabolic acidosis. This may be dose dependant in patients taking Sevelamer Hydrochloride.
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Affiliation(s)
- Zaw Thet
- Department of Nephrology, Western Health, Melbourne, Victoria, Australia.
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Ohno M, Ohashi H, Oda H, Yokoyama H, Okada M, Nagaya M, Izumi K, Ito H, Katoh S. Lanthanum carbonate for hyperphosphatemia in patients on peritoneal dialysis. Perit Dial Int 2013; 33:297-303. [PMID: 23209037 PMCID: PMC3649899 DOI: 10.3747/pdi.2012.00600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 05/05/2012] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Michiya Ohno
- Division of Nephrology, Murakami Memorial Hospital, Asahi University, Gifu 500-8523 Japan.
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Yamashita T, Ogawa T, Takahashi M, Mitsuhashi T, Shizuku J, Takahashi N, Ohba T, Miyajima S, Kabaya T, Otsuka K, Nitta K. Additional reduction in serum phosphorus levels by pulverized lanthanum carbonate chewable in hemodialysis patients. Ther Apher Dial 2013; 17 Suppl 1:54-9. [PMID: 23586514 DOI: 10.1111/1744-9987.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Indexed: 11/30/2022]
Abstract
Lanthanum carbonate (LC) is one of the relatively new phosphate binders. The general LC dosage form is a chewable pharmaceutical preparation. This investigation was targeted to subjects who do not chew LC chewable preparations adequately, for the purpose of studying the clinical efficacy of changing to pulverized prescriptions, such as changes in serum phosphorus levels (P levels). The study took place at Minamisenju Hospital in October 2011, with 41 subjects on maintenance hemodialysis. We pulverized all of the LC chewable medicines of the LC insufficient mastication group (non-chewing: NC group, n = 18) using a crusher, and changed them to pulverized prescriptions. The testing period was set at 10 weeks. In the NC group, there was a significant lowering of P levels from 5.86 ± 1.31 mg/dL before pulverization of the LC chewable preparation (week 0) to 5.38 ± 1.26 mg/dL after 2 weeks of administration of the pulverized medication (P = 0.0310), 5.20 ± 1.25 mg/dL after 4 weeks (P = 0.0077), and 5.12 ± 1.34 mg/dL after 6 weeks (P = 0.0167). P levels in other patients than NC group showed no significant change. In this study, the P levels in the NC group was lowered significantly by changing the LC chewable to the pulverized prescription, and the residual LC images on the abdominal X-rays disappeared to the point where they could barely be confirmed.
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Affiliation(s)
- Tetsuri Yamashita
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
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Takeuchi K, Matsuda E, Sekino M, Hasegawa Y, Kamo Y, Kikuchi N, Sekino H. Three-Year Follow-up of Lanthanum Carbonate Therapy in Hemodialysis Patients. Ther Apher Dial 2013; 17 Suppl 1:15-21. [DOI: 10.1111/1744-9987.12045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Indexed: 11/30/2022]
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Gotoh J, Kukita K, Tsuchihashi S, Hattori M, Iida J, Horie T, Onodera K, Furui H, Tamaki T, Meguro J, Yonekawa M, Kawamura A. Study of Prolonged Administration of Lanthanum Carbonate in Dialysis Patients. Ther Apher Dial 2013; 17 Suppl 1:9-14. [DOI: 10.1111/1744-9987.12043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Indexed: 12/01/2022]
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Ota S, Hirose M, Izumiya Y, Ishida Y. Effects of Switch From Sevelamer Hydrochloride to Lanthanum Carbonate on Serum K and Bone Metabolic Turnover. Ther Apher Dial 2013; 17 Suppl 1:49-53. [DOI: 10.1111/1744-9987.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Satoshi Ota
- Department of Blood Purification Therapy; Toyama City Hospital; Toyama; Japan
| | - Masayo Hirose
- Department of Blood Purification Therapy; Toyama City Hospital; Toyama; Japan
| | - Yoshiaki Izumiya
- Department of Blood Purification Therapy; Toyama City Hospital; Toyama; Japan
| | - Yoichi Ishida
- Department of Blood Purification Therapy; Toyama City Hospital; Toyama; Japan
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Ando R, Kimura H, Sato H, Iwamoto S, Yoshizaki Y, Chida Y, Ishida Y, Takayama M, Yamada K, Tachibana K, Ohtsuka M, Kikuchi K, Inoue A. Multicenter Study of Long-Term (Two-Year) Efficacy of Lanthanum Carbonate. Ther Apher Dial 2013; 17 Suppl 1:2-8. [DOI: 10.1111/1744-9987.12046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Ryoichi Ando
- Departments of Nephrology; Musashino Red Cross Hospital
| | | | - Hidehiko Sato
- Departments of Nephrology; Musashino Red Cross Hospital
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Fukagawa M, Komaba H, Kakuta T. Hyperparathyroidism in chronic kidney disease patients: an update on current pharmacotherapy. Expert Opin Pharmacother 2013; 14:863-71. [PMID: 23521343 DOI: 10.1517/14656566.2013.783017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Secondary hyperparathyroidism is the most common abnormalities of mineral metabolism in chronic kidney disease (CKD), which causes bone disease and vascular calcification, leading to increased risk of mortality. AREAS COVERED The aim of this review is to provide an overview of pharmacological therapies for secondary hyperparathyroidism, based on current understanding of the disease. EXPERT OPINION The initial event in the pathogenesis of secondary hyperparathyroidism is the phosphorus overload per nephron that lead to the secretion of a new phosphaturic hormone, fibroblast growth factor 23 from the bone. Such an abnormality develops very early in CKD, even without hyperphosphatemia. When hyperphosphatemia develops, phosphate binders are prescribed in many CKD patients. Non-calcium containing binders are gaining popularity because of less risk of excess calcium load; however, no specific superiority in patient-level outcomes has been fully established yet. For the direct control of parathyroid hormone secretion, cinacalcet hydrochloride has become widespread in addition to vitamin D receptor activators. As adverse events related to these therapeutic agents occur occasionally, however, and better adherence is one of the most important determinants of the benefits of the drugs, fewer adverse events as well as more potent therapeutic effects should be aimed in the development of new agents in future.
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Affiliation(s)
- Masafumi Fukagawa
- Tokai University School of Medicine, Division of Nephrology, Endocrinology, and Metabolism, 143 Shimo-Kasuya, Isehara, Kanagawa, 259-1193, Japan.
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Hutchison AJ, Gill M, Copley JB, Poole L, Wilson RJ. Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients. BMC Nephrol 2013; 14:40. [PMID: 23418668 PMCID: PMC3582545 DOI: 10.1186/1471-2369-14-40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/07/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This short-term study assessed the efficacy and safety of lanthanum carbonate in the treatment of hyperphosphatemia in dialysis patients; here, we report a prespecified subgroup analysis of patients undergoing peritoneal dialysis. METHODS Men and women (n=39) who had received continuous ambulatory peritoneal dialysis for chronic kidney disease for 6 months or more were enrolled in eight renal medicine departments in the United Kingdom. A 2-week washout period was followed by a 4-week dose-titration phase during which patients received lanthanum carbonate titrated up to 2250 mg/day. This was followed by a 4-week, randomized, placebo-controlled, parallel-group phase during which patients continued to receive either lanthanum carbonate at the titrated dose, or a matched dose of placebo. The main outcome measure was control of serum phosphate levels (1.3-1.8 mmol/l) at the end of the parallel-group phase. RESULTS Serum phosphate was controlled in 3/39 (8%) patients at the beginning of the dose-titration phase (after washout) and in 18/31 (58%) patients treated with lanthanum carbonate at its end. After the parallel-group phase, 60% of lanthanum carbonate-treated patients and 10% of those receiving placebo had controlled serum phosphate. There was no difference in mean (95% confidence interval) serum phosphate levels between groups at randomization: lanthanum carbonate, 1.57 (1.34-1.81) mmol/l; placebo, 1.58 (1.40-1.76) mmol/l (p=0.96). However, a difference was seen at the end of the parallel-group phase: lanthanum carbonate, 1.56 (1.33-1.79) mmol/l; placebo, 2.25 (1.81-2.68) mmol/l (p=0.0015). There were no clinically important changes in nutritional parameters and no serious treatment-related adverse events were recorded. CONCLUSIONS At doses up to 2250 mg/day, lanthanum carbonate is well tolerated and controls hyperphosphatemia effectively. Treatment with higher doses of lanthanum carbonate may allow patients undergoing peritoneal dialysis the potential to increase their dietary protein intake without compromising their phosphate control.
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Affiliation(s)
- Alastair J Hutchison
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, UK
- University of Manchester, Oxford Road, M13 9PL, Manchester, UK
| | - Maggie Gill
- Shire Pharmaceuticals, Hampshire International Business Park, Chineham, RG24 8EP, Basingstoke, UK
| | - J Brian Copley
- Shire Pharmaceuticals, 725 Chesterbrook Boulevard, 19087, Wayne, PA, USA
| | - Lynne Poole
- Shire Pharmaceuticals, Hampshire International Business Park, Chineham, RG24 8EP, Basingstoke, UK
| | - Rosamund J Wilson
- Spica Consultants, Granary House, Granary Close, East Grafton, SW8 3UA, Marlborough, UK
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Xu J, Zhang YX, Yu XQ, Liu ZH, Wang LN, Chen JH, Fan YP, Ni ZH, Wang M, Yuan FH, Ding GH, Chen XM, Zhang AP, Mei CL. Lanthanum carbonate for the treatment of hyperphosphatemia in CKD 5D: multicenter, double blind, randomized, controlled trial in mainland China. BMC Nephrol 2013; 14:29. [PMID: 23379590 PMCID: PMC3570485 DOI: 10.1186/1471-2369-14-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 01/14/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Serum phosphorus control is critical for chronic kidney disease (CKD) 5D patients. Currently, clinical profile for an oral phosphorus binder in the mainland Chinese population is not available. OBJECTIVE To establish the efficacy, safety, and tolerability of lanthanum carbonate in CKD 5D patients. DESIGN Multicenter, randomized, double blind, placebo-controlled study. A central randomization center used computer generated tables to allocate treatments. SETTING Twelve tertiary teaching hospitals and medical university affiliated hospitals in mainland China. PARTICIPANTS Overall, 258 hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) adult patients were enrolled. INTERVENTION After a 0-3-week washout period and a 4-week lanthanum carbonate dose-titration period, 230 patients were randomized 1:1 to receive lanthanum carbonate (1500 mg-3000 mg) or placebo for a further 4-week maintenance phase. MAIN OUTCOME MEASURES Efficacy and safety of lanthanum carbonate to achieve and maintain target serum phosphorus concentrations were assessed. RESULTS In the titration phase, serum phosphorus concentrations of all patients decreased significantly. About three-fifths achieved target levels without significantly disturbing serum calcium levels. At the end of the maintenance period, the mean difference in serum phosphorus was significantly different between the lanthanum carbonate and placebo-treated groups (0.63±0.62 mmol/L vs. 0.15±0.52 mmol/L, P < 0.001). The drug-related adverse effects were mild and mostly gastrointestinal in nature. CONCLUSION Lanthanum carbonate is an efficacious and well-tolerated oral phosphate binder with a mild AE profile in hemodialysis and CAPD patients. This agent may provide an alternative for the treatment of hyperphosphatemia in CKD 5D patients in mainland China. TRIAL REGISTRATION No. ChiCTR-TRC-10000817.
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Affiliation(s)
- Jing Xu
- Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi-Xiang Zhang
- Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xue-Qing Yu
- Department of Nephrology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhi-Hong Liu
- Department of Nephrology, Institute of Kidney Disease of the Chinese People's Liberation Army, Jingling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Li-Ning Wang
- Department of Nephrology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiang-Hua Chen
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ya-Ping Fan
- Department of Nephrology, Affiliated Hospital of Nantong Medical College, Jiangsu, China
| | - Zhao-Hui Ni
- Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mei Wang
- Department of Nephrology, People's Hospital of Peking University, Beijing, China
| | - Fa-Huan Yuan
- Institute of Nephrology of Chongqing and Department of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guo-Hua Ding
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiang-Mei Chen
- Chinese PLA Institute of Nephrology, Chinese PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Ai-Ping Zhang
- Department of Nephrology, General Hospital of Jinan Military Command, Jinan, Shandong, China
| | - Chang-Lin Mei
- Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Ghoreishi SM, Behpour M, Mazaheri S, Motaghedifard M. High Sensitive Sensor Based on Carbon Nanotube Electrode for Determination of Lanthanum in the Presence of Calcon Carboxylic Acid. ANAL LETT 2013. [DOI: 10.1080/00032719.2012.709894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Robijn S, Vervaet BA, Hoppe B, D'Haese PC, Verhulst A. Lanthanum carbonate inhibits intestinal oxalate absorption and prevents nephrocalcinosis after oxalate loading in rats. J Urol 2012; 189:1960-6. [PMID: 23228382 DOI: 10.1016/j.juro.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE Increased intestinal oxalate absorption leads to increased urinary oxalate excretion (secondary hyperoxaluria) and calcium oxalate crystal formation, contributing to nephrocalcinosis/lithiasis. Lanthanum carbonate is an intestinal phosphate binder that is orally administered to patients on dialysis to treat hyperphosphatemia. It is hypothesized that lanthanum can also bind oxalate, in addition to phosphate. We evaluated this in vitro and in vivo. MATERIALS AND METHODS In vitro oxalate binding was evaluated by oxalate precipitation from a solution by lanthanum. In vivo oxalate absorption kinetics and the effect of lanthanum carbonate on nephrocalcinosis development were assessed in male Sprague-Dawley® rats that received 1) 1,000 mg lanthanum carbonate and oxalate, 2) carboxymethylcellulose and oxalate or 3) carboxymethylcellulose by gavage for up to 12 hours (kinetics) or 7 days (nephrocalcinosis). Plasma and urinary oxalate concentrations were measured at several time points after gavage. The degree of nephrocalcinosis was assessed histomorphometrically on von Kossa stained sections and by measuring total calcium content in renal tissue. RESULTS In vitro lanthanum bound oxalate in a pH range comparable to the range of the intestine. In vivo oxalate administration in untreated animals resulted in a biphasic pattern of increased plasma oxalate levels, which was almost abolished in lanthanum treated rats. In the urine of treated rats oxaluria and calcium oxalate crystalluria were blunted. Moreover, significantly decreased nephrocalcinosis was observed compared with that in untreated rats. CONCLUSIONS Lanthanum carbonate is a promising agent for the future prevention/treatment of secondary hyperoxaluria.
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Affiliation(s)
- Stef Robijn
- Laboratory of Pathophysiology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
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