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Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis:
Nigel D Toussaint1, Kenneth K Lau, Kevan R Polkinghorne
1Departments of Nephrology Radiology, Monash Medical Centre Department of Medicine, Monash University, Clayton, Victoria, Australia. nigel.toussaint@med.monash.edu.au
Insights
Lanthanum carbonate (LC) significantly reduced aortic calcification progression in hemodialysis patients compared to calcium carbonate over 18 months. This pilot study suggests LC may be a beneficial phosphate binder for cardiovascular health.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Mineral Metabolism
Background:
- Vascular calcification (VC) is a significant contributor to cardiovascular disease in hemodialysis (HD) patients.
- Non-calcium-based phosphate binders may offer a therapeutic advantage in managing VC.
- No prior randomized studies have evaluated lanthanum carbonate (LC) for its impact on VC progression.
Purpose of the Study:
- To assess the efficacy of lanthanum carbonate (LC) in mitigating vascular calcification (VC) progression in hemodialysis (HD) patients.
- To compare the effects of LC versus calcium carbonate (CC) on aortic and superficial femoral artery (SFA) VC.
- To evaluate changes in bone mineral density (BMD) and mineral metabolism markers.
Main Methods:
- A pilot randomized controlled trial involving 45 HD patients randomized to LC or CC.
- Computed tomography (CT) scans were used at baseline, 6, and 18 months to measure VC and BMD.
- A random effect linear regression model analyzed differences in VC progression.
Main Results:
- Ninety-three percent of patients had baseline aortic VC, with 87% showing progression.
- Lanthanum carbonate demonstrated significantly less aortic VC progression compared to calcium carbonate (-98.1 HU, P < 0.001).
- No significant differences were observed in SFA VC, lumbar spine BMD, or serum mineral metabolism markers.
Conclusions:
- Lanthanum carbonate use was associated with a significant reduction in aortic calcification progression over 18 months in HD patients.
- This finding suggests a potential benefit of LC in managing vascular calcification in this patient population.
- Further research with larger sample sizes is warranted to confirm these results.
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.
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