Lanthanum carbonate

In studies comparing lanthanum carbonate with calcium carbonate, patients receiving lanthanum experience a similar degree of serum phosphate control with fewer episodes of hypercalcemia and potentially a lower pill burden (Nephron Clin Pract. 2008;110:c15-c23). The major side effects appear to be GI in nature. No published comparisons of lanthanum carbonate and calcium-based binder evaluate patient outcomes.

Where we stand

We know that hyperphosphatemia is associated with cardiovascular morbidity and mortality and that the use of phosphate binders is associated with improved survival of patients on dialysis. Furthermore, calcium-based binders are consistently associated with more episodes of hypercalcemia, which has been associated with mortality risk.

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However, clinical trials comparing calcium-based binders to sevelamer hydrochloride have not shown a consistent mortality benefit (high discontinuation rates may be skewing the results). Other effects of sevelamer hydrochloride, such as the induction of metabolic acidosis, may be responsible for the lack of mortality benefit.

In addition, therapy with sevelamer hydrochloride has been shown to decrease coronary and aortic calcification, although some of this effect may be a result of decreased LDL rather than a product of phosphate binding. Clinical outcomes with lanthanum and sevelamer carbonate are still being evaluated. Investigators note that further research needs to be conducted in this area.

Dr. Melamed is assistant professor in the Department of Medicine (Nephrology) and the Department of Epidemiology & Population Health at Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y.