A multicenter study on the effects of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients.
BACKGROUND
Lanthanum carbonate (LC) (Fosrenol) is a novel new treatment for hyperphosphatemia. In this phase III, open-label study, we compared the effects of LC and calcium carbonate (CC) on the evolution of renal osteodystrophy (ROD) in dialysis patients.


METHODS
Ninety-eight patients were randomized to LC (N = 49) or CC (N = 49). Bone biopsies were taken at baseline and after one year of treatment. Acceptable paired biopsies were available for static and dynamic histomorphometry studies in 33 LC and 30 CC patients. Blood samples were taken at regular intervals for biochemical analysis and adverse events were monitored.


RESULTS
LC was well tolerated and serum phosphate levels were well controlled in both treatment groups. The incidence of hypercalcemia was lower in the LC group (6% vs. 49% for CC). At baseline, subtypes of ROD were similarly distributed in both groups, with mixed ROD being most common. At one-year follow-up in the LC group, 5 of 7 patients with baseline low bone turnover (either adynamic bone or osteomalacia), and 4 of 5 patients with baseline hyperparathyroidism, had evolved toward a normalization of their bone turnover. Only one lanthanum-treated patient evolved toward adynamic bone compared with 6 patients in the CC group. In the LC group, the number of patients having either adynamic bone, osteomalacia, or hyperpara decreased overall from 12 (36%) at baseline to 6 (18%), while in the calcium group, the number of patients with these types of ROD increased from 13 (43%) to 16 (53%).


CONCLUSIONS
LC is a poorly absorbed, well-tolerated, and efficient phosphate binder. LC-treated dialysis patients show almost no evolution toward low bone turnover over one year (unlike CC-treated patients), nor do they experience any aluminum-like effects on bone.
D'Haese
Patrick C
PC
Department of Nephrology-Hypertension, University of Antwerp, Belgium.
Spasovski
Goce B
GB
Sikole
Aleksander
A
Hutchison
Alastair
A
Freemont
Tony J
TJ
Sulkova
Sylvie
S
Swanepoel
Charles
C
Pejanovic
Svetlana
S
Djukanovic
Llubica
L
Balducci
Alessandro
A
Coen
Giorgio
G
Sulowicz
Waldysaw
W
Ferreira
Anibal
A
Torres
Armando
A
Curic
Slobodan
S
Popovic
Milan
M
Dimkovic
Nada
N
De Broe
Marc E
ME
D000328:Adult; D000368:Aged; D015415:Biomarkers; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology; D002119:Calcium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000517:prevention & control; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007811:Lanthanum / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*
D015415:Biomarkers; D010710:Phosphates; C119467:lanthanum carbonate; D007811:Lanthanum; D002119:Calcium Carbonate