Lanthanum Carbonate Versus Sevelamer Hydrochloride: Improvement of Metabolic Acidosis and Hyperkalemia in Hemodialysis Patients

Abstract

Sevelamer hydrochloride (SH) has been reported to aggravate metabolic acidosis and hyperkalemia. This study was performed to evaluate acid-base status and serum potassium changes after replacing SH with lanthanum carbonate (LC) in hemodialysis patients. SH was prescribed for 24 weeks in 14 stable hemodialysis patients and replaced by LC in a similar treatment schedule. Laboratory tests, including indices of acid-base status, nutrition, bone/mineral metabolism, and dialysis adequacy, were performed monthly during the study. Dialysate bicarbonate, potassium and calcium concentrations remained constant. Serum bicarbonate and pH rose, and serum potassium dropped significantly under LC. Alkaline phosphatase also decreased significantly under LC. No significant differences were observed in the other studied parameters between the two treatment periods. Control of serum phosphate was similar under both phosphate-binders and no differences were observed in calcium, Ca × P product, CRP, or lipid levels. Dialysis adequacy was constantly kept within K/DOQI target-range. Although full compliance to treatment was reported, three patients on LC complained of gastrointestinal upset and/or a metallic taste, and four had difficulty chewing the LC tablet. LC improves metabolic acidosis and hyperkalemia in hemodialysis patients previously under SH. Although both medications are well-tolerated, the gastrointestinal side-effects appear to occur more frequently with LC; a fact that, together with difficulties in chewing the tablet, may result in decreased compliance.

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

“…Similarly, our meta-analysis found that the serum calcium level was lower in the LC group with no significant heterogeneity. Filiopoulos et al [31] compared sevelamer hydrochloride and LC in patients on hemodialysis and found a beneficial effect of switching from sevelamer hydrochloride to LC in terms of reducing metabolic acidosis and hyperkalemia. Moreover, several studies have shown that switching from sevelamer to LC could reduce drug costs and tablet burden while maintaining serum phosphate levels within the normal range [32, 33].…”

Randomized Crossover Study of the Efficacy and Safety of Sevelamer Hydrochloride and Lanthanum Carbonate in Japanese Patients Undergoing Hemodialysis

“…Consequently, the calcium‐ and aluminum‐free phosphate binders sevelamer hydrochloride (SH) and lanthanum carbonate (LC) have been available since 1998 and 2004, respectively (10,11). Although these new agents were reported to be easier to take and safe, few reports have compared SH and LC directly (12–14). The aim of this crossover study was to compare the short‐term efficacy and safety of SH and LC treatment in Japanese patients on HD.…”

Differential effects of phosphate binders on pre-dialysis serum bicarbonate in end-stage kidney disease patients on maintenance haemodialysis

“…However, SC is not available in Australia. Alternatively, switching from SH to lanthanum carbonate (LC) may improve metabolic acidosis and hyeprkalemia [26-28]. In our units (both Melbourne Health & Western Health), it was a standard practice to supplement bicarbonate at monthly blood audit when serum bicarbonate fell below 18.…”