Abstract
BackgroundChronic 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.MethodsA 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.ResultsSixteen 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.ConclusionsLC 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.
Highlights
Chronic kidney disease–mineral and bone disorder (CKD–MBD) is a common complication in CKD patients, in those with end-stage renal disease that requires dialysis
Our meta-analysis showed that when compared with previous phosphate binders, there was a lower rates of intradialytic hypotension (1 study, 1359 patients, risk ratios (RR): 0.66, 95% confidence intervals (CI): 0.53 to 0.82), cramps or myalgia (1 study, 1359 patients, RR: 0.76, 95% CI: 0.63 to 0.92), and abdominal pain (1 study, 1359 patients, RR: 0.73, 95% CI: 0.59 to 0.91) in Lanthanum carbonate (LC)-treated patient
A systematic review that evaluates the health economic effectiveness of LC must be conducted to serve as a guideline for clinicians in providing individualized therapies for different patients, for those in developing countries. The results of this meta-analysis show that lanthanum efficiently lowers the serum phosphorous and intact parathyroid hormone (iPTH) levels without elevating the serum calcium level
Summary
Chronic kidney disease–mineral and bone disorder (CKD–MBD) is a common complication in CKD patients, in those with end-stage renal disease that requires dialysis. With the progression of renal failure, patients frequently have disorders in bone and mineral metabolism [1]. This group of disorders is collectively called chronic kidney disease–mineral and bone disorder (CKD–MBD) and includes pathogenically linked biochemical abnormalities, bone diseases, and cardiovascular (CV) and soft tissue calcification [1]. Gradual decline in renal phosphorus clearance during CKD progression leads to hyperphosphatemia [2], which is a key factor in the development of MBD. Lowering the serum phosphorus levels is a promising therapeutic goal
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