Preface

Abstract

The 58th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) was held in Fukuoka from 20 to 23 June 2013, at the commercial and industrial centre of Kyushu Island (hosted by President, Hideki Hirakata MD, PhD, Fukuoka Red Cross Hospital). Over 3600 papers were presented in this meeting. Among them, CKD-MBD, which plays a critical role in the pathogenesis of cardiovascular disease among the dialysis population, was a current and noteworthy topic. At this annual JSDT meeting, many papers on phosphate (P) management were presented. It has been reported that excessive P load, along with decline in kidney function constitutes the bedrock of CKD-MBD. Therefore, P management is an issue of burning concern in clinical practice. In Japan, calcium (Ca) carbonate and three non-Ca-based phosphate binders, lanthanum carbonate (LC), sevelamer hydrochloride (SH), and bixalomer, are clinically available as P binders. Although Ca carbonate is cheap and well-tolerable, it has an increased risk for Ca overload, which might lead to vascular calcification and higher cardiovascular morbidity and mortality in CKD patients. Recently, a meta-analysis on 11 randomized controlled trials (4622 patients) that compared outcomes between CKD patients with Ca-based P binders and those with non-Ca-based binders demonstrates that all-cause mortality was significantly lower in patients with non-Ca-based P binders than those with Ca-based P binders (risk ratio 0.78, 95%CI 0.61–0.98) 1. The LC chewable tablet has been clinically available since 2004. In a randomized crossover study in hemodialysis patients, LC and SH improved serum P control to a similar extent without Ca overload 2. In treatment-related adverse events, constipation was significantly lower during LC treatment as compared with SH treatment. However, the chewable tablet formulation of LC could not exert its clinical effect without sufficient mastication. Recently, the granule formation of LC, which is likely to be more effective in reducing serum P concentrations even in patients with masticatory dysfunction, has become clinically available. This issue of the Therapeutic Apheresis and Dialysis Supplements contains six papers concerning recent progress in P management by LC treatment, which were presented in the 58th JSDT meeting. We are convinced that these papers will provide useful suggestions for P management in clinical settings. Conflict of interest: No potential conflict of interests.