Lanthanum carbonate for hyperphosphatemia in patients with advanced CKD and patients receiving dialysis

Reduced renal excretion of phosphate leads to hyperphosphatemia, which is prevalent in patients with end-stage renal disease, and is associated with increased morbidity and mortality. Dialysis alone is unable to adequately remove the ingested phosphate contained in food. It is therefore usually necessary to supplement food with drugs that reduce the intestinal absorption of dietary phosphate in order to control serum phosphate. Lanthanum carbonate is a recently introduced nonaluminum, noncalcium phosphate binder licensed for the management of serum phosphate in end-stage renal failure. It appears safe and effective, with data demonstrating no toxic effects in man after continuous exposure for up to 6 years. It is well tolerated and has a positive effect on bone histology in the context of renal osteodystrophy. Lanthanum carbonate's high affinity for phosphate rapid binding, palatability, low pill burden and absence of evident toxicity compare favorably with what are considered to be the ideal characteristics of an oral phosphate binder.