Lanthanum Carbonate Is an Effective Hypophosphatemic Agent for Hemodialysis Patients Intolerant of Other Phosphate Binders

Background Lanthanum carbonate (LC) is a noncalcium-containing phosphate binder of proven utility in treating hyperphosphatemia in dialysis patients, and displays a good tolerability profile. Objective This study addressed whether this tolerability profile could result in improved phosphate control in patients intolerant of other phosphate binders, and who remain hyperphosphatemic despite intensive dietary advice and adequate dialysis provision. Design, Setting, and Patients This 18-month study, from a large urban hemodialysis unit, studied 55 patients identified by the multidisciplinary team as fulfilling the following criteria: persistent hyperphosphatemia; intolerance of, or admitted nonadherence to, prescribed phosphate binders (either calcium-based or sevelamer); and provision of adequate dialysis (urea reduction ratio, >65%). Intervention and Main Outcome Measure LC was substituted for existing phosphate binders, and results were compared between baseline and 3 months after the initiation of LC. Results A significant fall in phosphate level from 2.28 ± 0.55 mmol/L to 1.89 ± 0.45 mmol/L (7.06 ± 1.70 mg/dL to 5.85 ± 1.39 mg/dL) was evident 3 months after the medication switch ( P < .001). This fall was associated with a significant increase in the number of patients achieving United Kingdom Renal Association guidelines for serum phosphate level (17% to 48%; P = .001). Mean phosphate-binder pill burden fell significantly by 3 months after the initiation of LC, from 7.8 ± 3.4 tablets daily to 3.6 ± 2.3 tablets daily. A small but significant increase also occurred in serum bicarbonate levels, from 23.3 ± 2.2 mmol/L (23.3 ± 2.2 mEq/L) at baseline to 23.9 ± 2.5 mmol/L (23.9 ± 2.5 mEq/L) at 3 months ( P = .03). This was observed despite a prescribed reduction in dialysate bicarbonate concentration across the population ( P = .03). Conclusion This study demonstrated the utility of LC in hemodialysis patients intolerant of alternative phosphate binders, and suggests an advantage of this agent in this patient group.