Blast from the past: the aluminum's ghost on the lanthanum salts.
Hyperphosphatemia is a common serious complication of chronic renal diseases, which needs appropriate continuous treatment in order to avoid ominous side effects. Therefore, oral chelating agents able to avoid phosphate absorption by the gut are mandatory. In the past, Aluminium salts, and more recently Calcium and Magnesium salts, and a synthetic resin polyallylamine hydrochloride have been employed, but Aluminium was later abandoned, because it has been a silent killer of many uremic patients, due to subtle absorption eventually leading to toxicity on Central Nervous System and bone, with allucinations, seizures, dementia, and osteomalacia, bone pain, fracturing osteodystrophy, and death. Recently, a new chelating agent able to bind dietary phosphate, namely Lanthanum carbonate has been introduced, with a proven efficacy profile for short-term treatment. However, after careful examination of the very few scientific papers available to date, we strongly advise caution before adopting, at present, lanthanum carbonate as a phosphate binder in uremic patients. In fact, notwithstanding minimized, some data are worrying: first, Lanthanum ions are absorbed, though at a minimal extent, by human gut; 2) pharmacokinetic evaluations show a greater exposure to Lanthanum in uremic patients;3) Lanthanum concentration is increased tenfold in blood and fivefold in bone after short-term supplementation in uremic patients; 4) there is no proofs that Lanthanum cannot cross the blood brain barrier in uremic patients; 5)Lanthanum has many biological effects and is potentially highly toxic. The Aluminum story should serve as cautionary tale when considering the use of new metal ions.
Canavese
Caterina
C
Nephrology and Transplantation, Department of Nephro-Urology, Avogadro University, Maggiore Hospital, Novara. ccanavese@hotmail.com
Mereu
Cristina
C
Nordio
Maurizio
M
Sabbioni
Enrico
E
Aime
Silvio
S
D019540:Area Under Curve; D002614:Chelating Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D007811:Lanthanum / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D010760:Phosphorus Metabolism Disorders / Q000097:blood / Q000188:drug therapy*; D006435:Renal Dialysis / Q000009:adverse effects
D002614:Chelating Agents; C119467:lanthanum carbonate; D007811:Lanthanum