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NDT Advance Access originally published online on June 24, 2008
Nephrology Dialysis Transplantation 2008 23(11):3677-3684; doi:10.1093/ndt/gfn310
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Switching to lanthanum carbonate monotherapy provides effective phosphate control with a low tablet burden

Alastair J. Hutchison1, Maurice Laville2 and on behalf of the SPD405-313 Lanthanum Study Group

1 Manchester Royal Infirmary, Manchester, UK 2 Service de Néphrologie, Université Claude-Bernard Lyon 1, Hôpital Edouard-Herriot, Lyon, France

Correspondence and offprint requests to: Alastair J. Hutchison, Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Tel: +44-161-2764488; Fax: +44-161-2768022; E-mail: alastair.hutchison{at}cmmc.nhs.uk



  Abstract

Background. Despite recognized risks associated with hyperphosphataemia in patients with chronic kidney disease (CKD) Stage 5 on dialysis, the achievement of target levels of serum phosphate is poor. It is likely that this is partly due to poor adherence by patients to their phosphate-binder treatment regimens, which often comprise large daily tablet burdens.

Methods. In this multicentre, open-label trial, patients on a stable dialysis regimen were screened while receiving phosphate-binder therapy, then entered into a washout phase. Patients with serum phosphate > 1.78 mmol/L after washout entered into the main 12-week treatment phase (N = 367), during which they were treated to target [Kidney Disease Outcomes Quality Initiative (K/DOQI)]: 1.13–1.78 mmol/L; 3.5–5.5 mg/dL) with lanthanum carbonate monotherapy. Efficacy variables included serum phosphate levels and the percentage of patients with serum phosphate control. Safety and tolerability assessments were also conducted.

Results. Mean serum phosphate levels were significantly reduced following 12 weeks of lanthanum carbonate monotherapy versus previous phosphate-binder therapy. The mean number of phosphate-binder tablets being taken per day at screening was 7.6, but during treatment with lanthanum carbonate, most patients were taking doses of up to 3000 mg/day, achievable with 3 x 1000 mg tablets per day (maximum of 6).

Conclusion. These findings suggest that lanthanum carbonate monotherapy offers effective control of serum phosphate and, due to a low tablet burden, may help to simplify the management of hyperphosphataemia in patients with CKD Stage 5.

Keywords: dialysis; hyperphosphataemia; lanthanum carbonate; phosphate binder; tablet burden

Received for publication: 23. 7.07
Accepted in revised form: 7. 5.08


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