Reducing high phosphate levels in patients with chronic renal failure undergoing dialysis: a 4-week, dose-finding, open-label study with lanthanum carbonate.
BACKGROUND
The majority of patients with end-stage renal disease on dialysis are hyperphosphataemic. Lanthanum carbonate has been shown to be a highly effective phosphate binder in pre-clinical studies. A 4-week, open-label, dose-titration trial was conducted to assess the ability of lanthanum carbonate to control phosphate levels in patients with chronic renal failure.


METHODS
This preliminary study was of 6 weeks duration: 2 weeks of washout followed by 4 weeks of dose titration. Patients (n = 59) were titrated on the basis of weekly serum phosphate levels from a daily dose of 375 mg lanthanum carbonate to a maximum dose of 2250 mg. Patients were maintained on the dose that controlled serum phosphate to between 1.30 and 1.80 mmol/l (4.03-5.58 mg/dl). Serum phosphate levels represented the main efficacy assessment. Safety was also evaluated.


RESULTS
Most patients were successfully titrated to 1500 and 2250 mg lanthanum/day (mean dose at end of titration: 1278 mg). At completion of the study 70% of patients achieved a serum phosphate of <or=1.80 mmol/l. The use of lanthanum carbonate in patients undergoing continuous ambulatory peritoneal dialysis or haemodialysis was generally well tolerated.


CONCLUSIONS
Lanthanum carbonate, a new non-aluminium, non-calcium phosphate binder, effectively reduces serum phosphate levels. Results of longer-term efficacy and safety studies are awaited with interest.
Hutchison
Alastair J
AJ
Manchester Institute of Nephrology and Transplantation, The Royal Infirmary, Manchester, UK. alastair.hutchison@cmmc.nhs.uk
Speake
Mary
M
Al-Baaj
Fouad
F
D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications* / Q000628:therapy; D007811:Lanthanum / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis; D013997:Time Factors; D017186:Titrimetry
D010710:Phosphates; C119467:lanthanum carbonate; D007811:Lanthanum