Clinical usefulness of lanthanum carbonate for serum phosphate control in difficult patients

The adequate control of phosphataemia is of major importance in end-stage renal disease patients on maintenance dialysis. Recently, lanthanum carbonate (LC) has been added to the phosphate binder armamentarium. To our knowledge, no studies have yet evaluated the usefulness of this drug in uncontrolled hyperphosphataemic patients.

This was a 6-month prospective observational study. Patients on chronic hemodialysis who had previously failed to achieve serum phosphate control were enrolled. Thirty-four patients (i.e. 11% out of 305 from three dialysis units) met the inclusion criteria. Lanthanum carbonate was introduced and titrated to achieve serum phosphate control, according to the KDOQI guidelines. Clinical targets, gastrointestinal symptoms, and patients' satisfaction with therapy were assessed at baseline and after 6 months.

Eight patients (23.5%) were withdrawn from the study due to side effects. In the remaining patients, serum phosphate level significantly decreased from 5.8 to 4.4 mg/dl and calcium-phosphate product also decreased significantly from 55.6 to 41.8 mg(2)/dl(2). The average number of all phosphate binder tablets taken per day was reduced from 6.7 to 4.7. Evaluation scores of dyspeptic symptoms and of patient's satisfaction with therapy also improved: from 7.5 to 5.3 and from 6.6 to 8.1, respectively.

The introduction of LC improved serum phosphate control in over 70% of these "difficult patients". A lower pill burden was also obtained, which might help to simplify treatment and increase patients' compliance. Dyspeptic symptoms and overall satisfaction with treatment also improved.