A Systematic Review of Lanthanum Carbonate for Hyperparathyroidism in Dialysis Patients_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yuchun , LI Zi ,  TANG Xiaohong

Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

TANG Xiaohong, Email: tangxiaohong177@sina.com.cn

Keywords：

Lanthanum carbonate; Final stage of renal failure; Hyperparathyroidism; Hemodialysis; Systematic review

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Objective 　To assess the efficacy and safety of Lanthanum Carbonate for hyperparathyroidism in dialysis patients.
Methods 　We searched MEDLINE (1996 to April 2006); EMBASE (1996 to April 2006); Cochrane Central Register of Controlled Trials (Issue 1, 2006); CBM disc; VIP and CNKI. We also checked the references of relevant studies. Randomized controlled trials (RCTs) comparing Lanthanum Carbonate with placebo and standard therapy were eligible for inclusion. Quality assessment and data extraction were done by two reviewers independently. Meta-analysis was conducted using The Cochrane Collaboration’s RevMan 4.2.8.
Results 　Six RCTs were included. Lanthanum Carbonate was found to be more effective than placebo in treating hyperparathyroidism of dialysis patients (OR 4.74, 95%CI 2.66 to 8.45; P lt;0.0001) and the incidence of all drug-related adverse events was similar between Lanthanum Carbonate and placebo-treated group (OR 1.23, 95%CI 0.74 to 2.04; P=0.42). The meta-analysis also showed that the efficacy of treating hyperparathyroidism of dialysis patients was similar between Lanthanum Carbonate and conventional phosphate binders (OR 0.97, 95%CI 0.74 to 1.27; P=0.81) and the incidence of all drug-related adverse events was also similar (OR 1.29, 95%CI 0.62 to 2.47; P=0.49). However, serum calcium level was lower in the Lanthanum Carbonate group than in the conventional phosphate binders group.
Conclusion 　Lanthanum Carbonate is effective and well-tolerated in treating hyperparathyroidism of dialysis patients with end-stage renal disease(ESRD). The incidence of hypercalcemia induced by Lanthanum Carbonate is significantly lower than that of the conventional phosphate binders. However, more large-scale, randomized, double-blinded trials are required to investigate the long-term safety and efficacy of Lanthanum Carbonate.

Citation： GAO Yuchun,LI Zi,TANG Xiaohong. A Systematic Review of Lanthanum Carbonate for Hyperparathyroidism in Dialysis Patients. Chinese Journal of Evidence-Based Medicine, 2006, 06(10): 727-732. doi: Copy

1.	.12 Joy MS, Finn WF. LAM-302 Study Group; Randomized, double-blind, placebo-controlled, dose-titration, phase III study assessing the efficacy and tolerability of lanthanum carbonate: a new phosphate binder for the treatment of hyperphosphatemia. American Journal of Kidney Diseases, 2003; 42(1): 96–107.
2.	Malluche HH, Monier-Faugere MC. Understanding and managing hyperphosphatemia in patients with chronic renal disease. Clin Nephrol, 1999; 52 (15): 267–277.
3.	Block GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and calcium_phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis, 1998; 31 (66): 607–617.
4.	Albaaj F, Hutchison A. Hyperphosphataemia in renal failure: causes, consequences and current management. Drugs, 2003; 63 (6): 577–596.
5.	Indridason OS, Quarles LD. Hyperphosphatemia in end-stage renal disease. Adv Ren Replace Ther, 2002; 9 (3): 184–192.
6.	Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis, 2000; 35 (723): 1226–1237.
7.	Kates DM, Andress DL: Control of hyperphosphatemia in renal failure: role of aluminum. Semin Dial, 9:301–315, 1996.
8.	Sperschneider H, Gunther K, Marzoll I, et al. Calcium carbonate (CaCO3): an efficient and safe phosphate binder in haemodialysis patients? A 3-year study, Nephrol Dial Transplant, 1993; 8:530–534.
9.	Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med, 2000; 342(485): 1478–1483.
10.	Schaefer K. Alternative phosphate binders: an update. Nephrol Dial Transplant, 1993; 1(2): 35–39.
11.	Locatelli F, D’Amico M. Lanthanum carbonate AnorMED. Curr Opin Cardiovasc Pulmon Renal Invest Drugs, 2000; 2 (4): 372–377.
12.	D’Haese PC. Spasovski GB. Sikole A, et al. A multicenter study on the effects of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney International- Supplement, 2003; 1(85): S73–78.
13.	Finn WF, Joy MS, Hladik G. Lanthanum Study Group; Efficacy and safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis. Clinical Nephrology, 2004; 62(3): 193–201.
14.	Chiang SS, Chen JB, Yang WC. Lanthanum carbonate (Fosrenol) efficacy and tolerability in the treatment of hyperphosphatemic patients with end-stage renal disease. Clinical Nephrology, 2005; 63(6): 461–470.
15.	Al-Baaj F, Speake M, Hutchison AJ. Control of serum phosphate by oral lanthanum carbonate in patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis in a short-term, placebo-controlled study, 2005; 20(4): 775–782.
16.	Hutchison AJ, Maes B, Vanwalleghem J, et al. Efficacy, tolerability, and safety of lanthanum carbonate in hyperphosphatemia: a 6-month, randomized, comparative trial versus calcium carbonate. Nephron Clinical Practice, 2005; 100(1): C8–C19.
17.	Finn WF. SPD 405-307 Lanthanum Study Group; Lanthanum carbonate versus standard therapy for the treatment of hyperphosphatemia: safety and efficacy in chronic maintenance hemodialysis patients. Clinical Nephrology, 2006; 65(3): 191–202.

1. .12 Joy MS, Finn WF. LAM-302 Study Group; Randomized, double-blind, placebo-controlled, dose-titration, phase III study assessing the efficacy and tolerability of lanthanum carbonate: a new phosphate binder for the treatment of hyperphosphatemia. American Journal of Kidney Diseases, 2003; 42(1): 96–107.
2. Malluche HH, Monier-Faugere MC. Understanding and managing hyperphosphatemia in patients with chronic renal disease. Clin Nephrol, 1999; 52 (15): 267–277.
3. Block GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and calcium_phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis, 1998; 31 (66): 607–617.
4. Albaaj F, Hutchison A. Hyperphosphataemia in renal failure: causes, consequences and current management. Drugs, 2003; 63 (6): 577–596.
5. Indridason OS, Quarles LD. Hyperphosphatemia in end-stage renal disease. Adv Ren Replace Ther, 2002; 9 (3): 184–192.
6. Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis, 2000; 35 (723): 1226–1237.
7. Kates DM, Andress DL: Control of hyperphosphatemia in renal failure: role of aluminum. Semin Dial, 9:301–315, 1996.
8. Sperschneider H, Gunther K, Marzoll I, et al. Calcium carbonate (CaCO3): an efficient and safe phosphate binder in haemodialysis patients? A 3-year study, Nephrol Dial Transplant, 1993; 8:530–534.
9. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med, 2000; 342(485): 1478–1483.
10. Schaefer K. Alternative phosphate binders: an update. Nephrol Dial Transplant, 1993; 1(2): 35–39.
11. Locatelli F, D’Amico M. Lanthanum carbonate AnorMED. Curr Opin Cardiovasc Pulmon Renal Invest Drugs, 2000; 2 (4): 372–377.
12. D’Haese PC. Spasovski GB. Sikole A, et al. A multicenter study on the effects of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney International- Supplement, 2003; 1(85): S73–78.
13. Finn WF, Joy MS, Hladik G. Lanthanum Study Group; Efficacy and safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis. Clinical Nephrology, 2004; 62(3): 193–201.
14. Chiang SS, Chen JB, Yang WC. Lanthanum carbonate (Fosrenol) efficacy and tolerability in the treatment of hyperphosphatemic patients with end-stage renal disease. Clinical Nephrology, 2005; 63(6): 461–470.
15. Al-Baaj F, Speake M, Hutchison AJ. Control of serum phosphate by oral lanthanum carbonate in patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis in a short-term, placebo-controlled study, 2005; 20(4): 775–782.
16. Hutchison AJ, Maes B, Vanwalleghem J, et al. Efficacy, tolerability, and safety of lanthanum carbonate in hyperphosphatemia: a 6-month, randomized, comparative trial versus calcium carbonate. Nephron Clinical Practice, 2005; 100(1): C8–C19.
17. Finn WF. SPD 405-307 Lanthanum Study Group; Lanthanum carbonate versus standard therapy for the treatment of hyperphosphatemia: safety and efficacy in chronic maintenance hemodialysis patients. Clinical Nephrology, 2006; 65(3): 191–202.

Chinese Journal of Evidence-Based Medicine

A Systematic Review of Lanthanum Carbonate for Hyperparathyroidism in Dialysis Patients

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