Efficacy and safety of lanthanum carbonate versus calcium-based phosphate binders in patients with chronic kidney disease: a systematic review and meta-analysis.
OBJECTIVE
We conducted this review to assess the relative efficacy and safety of lanthanum carbonate versus calcium-based phosphate binders in chronic kidney disease.


METHODS
We systematically searched PubMed, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials and Chinese Biological Medical Database for randomized controlled trials comparing lanthanum carbonate with calcium-based phosphate binders in adult patients with chronic kidney disease. Study quality was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of intervention. Meta-analysis was conducted by reviewer manager software, version 5.3.


RESULTS
Eleven trials with 1,501 participants were included. Lanthanum carbonate appeared to be associated with a significant reduction in progression of vascular calcification and a beneficial effect on bone outcomes without aluminum-like toxicity. Lanthanum carbonate achieved similar proportions of phosphate-controlled patients (RR 0.63, 95% CI 0.27-1.44) with lower incidence of hypercalcemia (RR 0.13, 95% CI 0.05-0.35) in comparison with calcium-based phosphate binders. Lanthanum carbonate was associated with significantly lower serum calcium, similar serum Ca × P product and higher serum iPTH compared with calcium salts in patients with chronic kidney disease.


CONCLUSIONS
Lanthanum carbonate could delay the progression of vascular calcification and benefit chronic kidney disease patients on bone outcomes. Lanthanum carbonate could achieve similar proportion of phosphate-controlled patients as calcium-based phosphate binders with lower incidence of hypercalcemia.
Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
Chun-Juan
CJ
Zhai
Xiao-Wei
XW
Yang
Jing
J
Sun
Rong
R
Wang
D015519:Bone Density / Q000187:drug effects; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000627:therapeutic use; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood; D007811:Lanthanum / Q000009:adverse effects / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000517:prevention & control*
D002614:Chelating Agents; D010281:Parathyroid Hormone; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D002119:Calcium Carbonate; D002118:Calcium