Effect of lanthanum carbonate and calcium acetate in the treatment of hyperphosphatemia in patients of chronic kidney disease

Abstract

Objectives:The tolerability and efficacy of lanthanum carbonate has not been studied in the Indian population. This study was, therefore, undertaken to compare the efficacy and tolerability of lanthanum carbonate with calcium acetate in patients with stage 4 chronic kidney disease.Design:A randomized open label two group cross-over study.Materials and Methods:Following Institutional Ethics Committee approval and valid consent, patients with stage 4 chronic kidney disease were randomized to receive either lanthanum carbonate 500mg thrice daily or calcium acetate 667 mg thrice daily for 4 weeks. After a 4-week washout period, the patients were crossed over for another 4 weeks. Serum phosphorous, serum calcium, serum alkaline phosphatase, and serum creatinine were estimated at fixed intervals.Results:Twenty-six patients were enrolled in the study. The mean serum phosphorous concentrations showed a declining trend with lanthanum carbonate (from pre-drug levels of 7.88 ± 1.52 mg/dL-7.14 ± 1.51 mg/dL) and calcium acetate (from pre-drug levels of 7.54 ± 1.39 mg/dL-6.51 ± 1.38 mg/dL). A statistically significant difference was seen when comparing the change in serum calcium produced by these drugs (P < 0.05). Serum calcium levels increased with calcium acetate (from pre-drug levels of 7.01 ± 1.07-7.46 ± 0.74 mg dL), while it decreased with lanthanum carbonate (from pre-drug levels 7.43 ± 0.77-7.14 ± 0.72 mg/dL). The incidence of adverse effects was greater with lanthanum carbonate.Conclusion:Lanthanum carbonate and calcium acetate are equally effective phosphate binders with trends obvious in the first 4 weeks of therapy. The decrease in serum calcium levels with lanthanum carbonate when compared to the increase in serum calcium levels due to calcium acetate is statistically significant. The drawback of lanthanum carbonate is its high cost and relatively higher incidence of adverse events during treatment.

Cyclic Voltammetric studies of calcium acetate salt with Methylene blue (MB) Using Gold Electrode

“…The electrochemical redox behavior of Ca +2 ions in the presence of MB at the GE was studied at the steady state current, cyclic waves were obtained and explained using equations (1)(2)(3)(4)(5)(6).…”

“…Calcium acetate is used to decrease and prevent blood phosphate levels in patients suffering from dialysis due to kidney disease [1]. Hyperphosphatemia has a universal effect in patients with chronic disease [2]. Dialysis can remove some phosphate from the blood, but it is hard to remove enough to control the phosphate level [1,2].…”

“…Hyperphosphatemia has a universal effect in patients with chronic disease [2]. Dialysis can remove some phosphate from the blood, but it is hard to remove enough to control the phosphate level [1,2]. Decreasing on the blood phosphate levels help to keep bones strong, prevent unsafe build up of minerals in the body and decrease the heart diseases.…”

The effect of lanthanum carbonate on metabolic acidosis in patients with chronic kidney disease stage IV, V and V-D

“…Its efficacy compared to placebo or other phosphate binders has been demonstrated in hemodialysis patients and in CKD IV-V patients [7][8][9][10][11][12][13][14][15][16]. Doses of lanthanum carbonate ranging from 1 to 4.5 g per day will contribute 6.5-30 mmol of carbonate per day.…”

Cost-Effectiveness of Lanthanum Carbonate in the Treatment of Hyperphosphatemia in Chronic Kidney Disease Before and During Dialysis

“…Lanthanum carbonate (LC) is a noncalcium-based phosphate binding agent licensed for hyperphosphatemic dialysis patients [15,16] and recently also for CKD patients not yet on dialysis [17,18]. Treatment with LC after therapy failure with calcium carbonate treatment (i.e., secondline LC treatment) was found to constitute good value-for-money in dialysis patients [19].…”