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Lanthanum carbonate is highly insoluble and therefore has a low turnover (adynamic bone disease or osteomalacia) at baseline tended to
potential for accumulation compared with aluminium (0.00089% versus show improved bone histology in the lanthanum carbonate group
0.05–0.1% absorption of the oral dose) and does not appear to cross the compared with those in the calcium carbonate group, where low
blood–brain barrier. Also, it has no effect on the absorption of fat-soluble turnover lesions persisted (71% versus 42%, respectively).
Lanthanum carbonate has been studied in over 5,000 patients is particularly important in excluding any aluminium-like effect on
in clinical trials before launch. These studies showed good control of osteoblast function. Thus, it appears that the evolution towards low bone
phosphate levels over short- and long-term follow-up (up to six years).
turnover lesions that is often seen in calcium-treated dialysis patients is
Low serum lanthanum levels were detectable in the majority of patients not seen with lanthanum carbonate. No correlations between bone
(0.1–0.8ng/l). This increase was noted for all doses administered versus lanthanum content, PTH levels or bone histology were found.
baseline and levels reached a plateau early in the study, then showed no Lanthanum is priced equally to sevelmer (see Table 2).
further increase. Furthermore, they were not dose-dependent and there
are no reported pathological or toxic consequences associated with the Conclusion
increase in plasma lanthanum concentration. The incidence of adverse Hyperphosphataemia remains one of the major and modifiable risk
events was comparable to the placebo group, and it is reported that they factors for mortality in ESRD patients, and all means at our disposal must
are minimised if taken with – or preferably immediately after – food, and be used to prevent it. However, we must begin to individualise
generally abate with time and continued dosing.
phosphate-binder therapy according to bone mineral indices and the
presence of vascular calcification to make the right choice and dose, at
The effects on bone were examined in a large-scale (98 patients) the lowest cost. Indeed, the best phosphate binder is still the one that the
histology-based study: after one year of treatment there was a trend patient will take, so potency and pill burden are perhaps the most
towards improved histology. However, the patients with low bone important considerations from the patient’s perspective. ■
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