NDT Advance Access originally published online on April 4, 2006
Nephrology Dialysis Transplantation 2006 21(8):2217-2224; doi:10.1093/ndt/gfl146
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up
1 Department of Nephrology, University of Skopje, Macedonia, 2 Department of Osteoarticular Pathology, The Medical School, University of Manchester, UK, 3 Shire Pharmaceuticals Group plc, Basingstoke, UK and 4 Department of Physiopathology, Facutlty of Medicine, University of Antwerp, Belgium
Correspondence and offprint requests to: Goce B. Spasovski, MD, PhD, Department of Nephrology, University Clinical Center, Vodnjanska 17, 1000 Skopje, Macedonia. Email: gspas{at}sonet.com.mk
Background. Lanthanum carbonate (LC) has been proposed as a new phosphate binder. Presented here are the results from one centre that participated in a multicentre trial to assess the effect of treatment with LC and calcium carbonate (CC) on the evolution of renal osteodystrophy in dialysis patients. Bone biopsies were performed at baseline, after 1 year of treatment and after a further 2-year follow-up period to assess the lanthanum concentration in bone and plasma.
Methods. Twenty new dialysis patients were randomized to receive LC (median dose 1250 mg) for 1 year (n = 10), followed by 2 years of CC treatment or CC (n = 10) during the whole study period (3 years).
Results. After 36 weeks of treatment, steady state was reached with plasma lanthanum levels varying around 0.6 ng/ml. Six weeks after cessation of 1 year of treatment, the plasma lanthanum levels declined to a value of 0.17 ± 0.12 ng/ml (P < 0.05) and after 2 years to 0.09 ± 0.03 ng/ml. Plasma and bone lanthanum levels did not correlate with the average lanthanum dose at any time point. The mean bone concentration in patients receiving LC increased from 0.05 ± 0.03 to 2.3 ± 1.6 µg/g (P < 0.05) after 1 year and slightly decreased at the end of the study to 1.9 ± 1.6 µg/g (P < 0.05).
Conclusions. Bone deposition after 1 year of treatment with LC is low (highest concentration: 5.5 µg/g). There is a slow release of lanthanum from its bone deposits 2 years after the discontinuation of the treatment and no association with aluminium-like bone toxicity.
Keywords: bone biopsy; calcium carbonate; lanthanum carbonate; renal failure; renal osteodystrophy
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