title: Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis: A pilot randomized controlled trial.
abstract: BACKGROUND
  Vascular calcification (VC) contributes to cardiovascular disease in haemodialysis (HD) patients. Few controlled studies have addressed interventions to reduce VC but non-calcium-based phosphate binders may be beneficial. No published randomized study to date has assessed the effect of lanthanum carbonate (LC) on VC progression.
  
  
  METHODS
  We conducted a pilot randomized controlled trial to determine the effect of LC on VC. Forty-five HD patients were randomized to either LC or calcium carbonate (CC). Primary outcome was change in aortic VC after 18 months. Secondary outcomes included superficial femoral artery (SFA) VC, bone mineral density (BMD) of lumbar spine and serum markers of mineral metabolism. At baseline, 6 and 18 month computed tomography was performed to measure VC and BMD. A random effect linear regression model was performed to assess differences.
  
  
  RESULTS
  Thirty patients completed the study (17 LC, 13 CC); baseline median age 58 years, 38% diabetic, 64% male. Ninety-three per cent had aortic VC at commencement and 87% showed progression. At 18 months, there was significantly less aortic VC progression with LC than CC (adjusted difference -98.1 (-149.4, -46.8) Hounsfield units (HU), P < 0.001). There was also a non-significant reduction with LC in left SFA VC (-25.8 (-67.7, 16.1) HU, P = 0.2) and right SFA VC (-35.9 (-77.8, 5.9) HU, P = 0.09). There was no difference in lumbar spine BMD and serum phosphate, calcium and parathyroid hormone levels between groups. Limitations to the study include small sample size and loss to follow up.
  
  
  CONCLUSIONS
  Lanthanum carbonate was associated with reduced progression of aortic calcification compared with CC in HD patients over 18 months.
authors.affiliation: Departments of Nephrology Radiology, Monash Medical Centre Department of Medicine, Monash University, Clayton, Victoria, Australia. nigel.toussaint@med.monash.edu.au
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Toussaint
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Lau
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D002114:Calcinosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D007811:Lanthanum / Q000627:therapeutic use*; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*; D010865:Pilot Projects; D006435:Renal Dialysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; C119467:lanthanum carbonate; D007811:Lanthanum; D002119:Calcium Carbonate; D002118:Calcium