Lanthanum carbonate vs. sevelamer hydrochloride for the reduction of serum phosphorus in hemodialysis patients: a crossover study.
OBJECTIVE
The aim of this crossover study was to compare the reduction of serum phosphorus (SP) with fixed doses of the non-calcium-containing phosphate binders lanthanum carbonate (LC) and sevelamer hydrochloride (SH) in hemodialysis patients.


METHODS
Following washout (2 - 3 weeks), 182 patients with SP >or= 6.0 mg/dl and calcium >or= 8.4 mg/dl were randomized (1:1) to receive LC (2,250 to 3,000 mg/day) or SH (4,800 to 6,400 mg/day) for 4 weeks. Patients underwent a second washout (2 weeks) and switched to the alternative binder for 4 weeks.


RESULTS
At the end of treatment, LC had reduced SP by 1.7 +/- 0.1 mg/dl, compared with 1.4 +/- 0.1 mg/dl for SH; the difference was not statistically significant in the primary analysis (LOCF, p = 0.133). However, the reduction with LC was significantly greater than with SH in a prespecified key secondary analysis of patients who completed 4 weeks of treatment with each binder (0.5 mg/dl difference, p = 0.007). The reduction of SP was also greater with LC than SH after 1 week of treatment (p = 0.024).


CONCLUSIONS
Although the primary analysis found no difference between LC and SH in the reduction of SP, a significant difference in favor of LC was observed in patients who completed treatment. The results of this study show interesting trends with respect to onset and duration of action that warrant further investigation in longer-term studies.
Sprague
S M
SM
NorthShore University HealthSystem, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA. stuartmsprague@gmail.com
Ross
E A
EA
Nath
S D
SD
Zhang
P
P
Pratt
R D
RD
Krause
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D007811:Lanthanum / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D011073:Polyamines / Q000008:administration & dosage / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer; D016896:Treatment Outcome
D015415:Biomarkers; D002614:Chelating Agents; D010281:Parathyroid Hormone; D011073:Polyamines; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002118:Calcium