title: Survival advantage of lanthanum carbonate for hemodialysis patients with uncontrolled hyperphosphatemia.
abstract: BACKGROUND
  Lanthanum carbonate is a non-calcium phosphate binder that is effective for the treatment of hyperphosphatemia. However, it is unknown whether treatment with lanthanum affects survival.
  
  
  METHODS
  We retrospectively collected data on maintenance hemodialysis patients at 22 facilities (n = 2292) beginning in December 2008, a time point immediately prior to the commercial availability of lanthanum in Japan. We compared 3-year all-cause mortality among patients who initiated lanthanum (n = 560) and those who were not treated with lanthanum during the study period (n = 560) matched by the propensity score of receiving lanthanum. Several sensitivity analyses were performed to test the robustness of the primary analysis.
  
  
  RESULTS
  After the market introduction of lanthanum, the percentage of patients receiving the binder increased gradually to 27%. In the propensity score-matched analysis, the mortality rate for the lanthanum group was not significantly lower than the non-lanthanum group [hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.47-1.09). However, stratification by serum phosphorus disclosed significant survival benefit of lanthanum for patients with serum phosphorus >6.0 mg/dL (HR, 0.52; 95% CI, 0.28-0.95), but not in patients with serum phosphorus ≤6.0 mg/dL (HR, 1.00; 95% CI, 0.55-1.84). The survival benefit of lanthanum in patients with serum phosphorus >6.0 mg/dL was consistent across subgroups and robust in different analytical approaches.
  
  
  CONCLUSIONS
  Treatment with lanthanum was independently associated with a significant survival benefit in hemodialysis patients with inadequately controlled hyperphosphatemia. Further studies are required to confirm these findings.
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kakuta
authors.affiliation: Division of Nephrology and Diabetes, Tokai University Oiso Hospital, Oiso, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Medical Corporation Kuratakai, Hiratsuka, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Hida
authors.affiliation: Medical Corporation Showakai, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Suga
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D007811:Lanthanum / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood*; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum
keywords: hemodialysis; hyperphosphatemia; lanthanum carbonate; survival