Attenuation of aortic calcification with lanthanum carbonate versus calcium-based
phosphate binders in haemodialysis: A pilot randomized controlled trial.
Author(s): Toussaint ND, Lau KK, Polkinghorne KR, Kerr PG.
Affiliation(s): Departments of Nephrology Radiology, Monash Medical Centre Department of
Medicine, Monash University, Clayton, Victoria, Australia.
nigel.toussaint@med.monash.edu.au
Publication date & source: 2011, Nephrology (Carlton). , 16(3):290-8
BACKGROUND: Vascular calcification (VC) contributes to cardiovascular disease in
haemodialysis (HD) patients. Few controlled studies have addressed interventions
to reduce VC but non-calcium-based phosphate binders may be beneficial. No
published randomized study to date has assessed the effect of lanthanum carbonate
(LC) on VC progression.
METHODS: We conducted a pilot randomized controlled trial to determine the effect
of LC on VC. Forty-five HD patients were randomized to either LC or calcium
carbonate (CC). Primary outcome was change in aortic VC after 18 months.
Secondary outcomes included superficial femoral artery (SFA) VC, bone mineral
density (BMD) of lumbar spine and serum markers of mineral metabolism. At
baseline, 6 and 18 month computed tomography was performed to measure VC and BMD.
A random effect linear regression model was performed to assess differences.
RESULTS: Thirty patients completed the study (17 LC, 13 CC); baseline median age
58 years, 38% diabetic, 64% male. Ninety-three per cent had aortic VC at
commencement and 87% showed progression. At 18 months, there was significantly
less aortic VC progression with LC than CC (adjusted difference -98.1 (-149.4,
-46.8) Hounsfield units (HU), P < 0.001). There was also a non-significant
reduction with LC in left SFA VC (-25.8 (-67.7, 16.1) HU, P = 0.2) and right SFA
VC (-35.9 (-77.8, 5.9) HU, P = 0.09). There was no difference in lumbar spine BMD
and serum phosphate, calcium and parathyroid hormone levels between groups.
Limitations to the study include small sample size and loss to follow up.
CONCLUSIONS: Lanthanum carbonate was associated with reduced progression of
aortic calcification compared with CC in HD patients over 18 months.
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