Effect of treatment of hyperphosphatemia with lanthanum carbonate versus calcium carbonate on cardiovascular events among chronic kidney disease patients on hemodialysis
Among patients undergoing hemodialysis with hyperphosphatemia and at least one vascular calcification risk factor, treatment of hyperphosphatemia with lanthanum carbonate compared with calcium carbonate did not result in a significant difference in composite cardiovascular events. However, the event rates were low and the findings may not apply to patients at higher risk.
Ogata H, Fukagawa M, Hirakata H, et al. Effect of treatment of hyperphosphatemia with lanthanum carbonate versus calcium carbonate on cardiovascular events in chronic kidney disease patients undergoing hemodialysis: a landmark randomized clinical trial. JAMA. 2021; 325(19): 1946-1954. doi: 10.1001 / jama.2021.4807
Commentary
This study tested the effectiveness of a non-calcium-based phosphorus adsorbent as an intervention to reduce cardiovascular disease in patients with hyperphosphatemia who were on dialysis. The purpose of the study was to determine if lanthanum carbonate was more effective than calcium carbonate.
The study
An open-label, randomized, parallel-group clinical trial with blinded endpoint determination was conducted in 2374 patients with chronic kidney disease. Interventions were randomized to receive either lanthanum carbonate (n = 1154) or calcium carbonate (n = 1155), titrated to achieve serum phosphate levels of 3.5 mg / dL to 6.0 mg / dL.
As a result, from 2309 randomized patients, 1851 (80.2%) completed the study; after 16 years, the occurrence of cardiovascular disease was reported in 147 of 1063 patients in the calcium lanthanum group and 134 of 1072 patients in the calcium carbonate group. There was also no significant difference in death from all causes or hip fracture. An increased risk of cardiovascular death and secondary hyperparathyroidism was also reported in the lanthanum carbonate group. Adverse events occurred in 282 (25.7%) patients in the lanthanum carbonate group and 259 (23.4%) patients in the calcium carbonate group.
