Switching Phosphate Binders May Help Treatment Failures

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NASHVILLE—Data from a small study suggest that dialysis patients can achieve adequate phosphorus control if they switch to lanthanum carbonate after unsuccessful treatment with other phosphate binders.

At the National Kidney Foundation's 2009 Spring Clinical Meetings here, Linda Noto, RD, of Western New York Dialysis Centers in Orchard Park, N.Y., reported results of a 12-month study of 17 dialysis patients (mean age 66 years) who switched to lanthanum carbonate because their previous binders (calcium carbonate, calcium acetate, and sevelamer hydrochloride) were ineffective, patients could not tolerate the medication, or the treatments resulted in elevated calcium levels.

Patients also received education and counseling related to phosphorus control. Of the 17 patients, 14 had serum phosphorus levels exceeding the 5.5 mg/dL threshold recommended in Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines.

Following the switch to lanthanum carbonate, mean serum phosphorus levels declined significantly from 6.37 to 5.27 mg/dL after 12 months of treatment. The overall proportion of patients with phosphorus levels within the K/DOQI guidelines rose from three of 17 patients (18%) before the switch to 11 of 17 patients (65%) by 12 months after the switch. Of 14 patients whose serum phosphorus levels exceeded 5.5 mg/dL before the switch, six fell to within K/DOQI guidelines within the first three months and nine fell to within the guidelines at months 10-12.

During the 12 months of lanthanum carbonate treatment, patients had a mean serum albumin level of 3.78 g/dL, suggesting that their nutritional status was maintained.

The observed decrease in phosphorus levels is likely attributable to lanthanum carbonate rather than education and counseling because these latter interventions were implemented before the switch to lanthanum carbonate, the researchers noted.

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