Switching phosphate binders may help treatment failures

Data from a small study suggest that dialysis patients can achieve adequate phosphorus control if they switch to lanthanum carbonate after unsuccessful treatment with other phosphate binders.

Originally published on Renal and Urology News - World Review For Urologists and Nephrologists.

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Linda Noto, RD, of Western New York Dialysis Centers in Orchard Park, NY, reported results of a 12-month study of 17 dialysis patients (mean age 66 years) who switched to lanthanum carbonate because their previous binders (calcium carbonate, calcium acetate, and sevelamer hydrochloride) were either ineffective, patients could not tolerate the medication, or the treatments resulted in elevated calcium levels. Patients also received education and counselling related to phosphorus control. Of the 17 patients, 14 had serum phosphorus levels exceeding the 5.5 mg/dL threshold recommended in Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.

Following the switch to lanthanum carbonate, mean serum phosphorus levels declined significantly from 6.37 to 5.27 mg/dL after 12 months of treatment. The overall proportion of patients with phosphorus levels within the KDOQI guidelines rose from three of 17 patients (18%) before the switch to 11 of 17 patients (65%) by 12 months after the switch. Of 14 patients whose serum phosphorus levels exceeded 5.5 mg/dL before the switch, six fell to within KDOQI guidelines at months 1-3 and nine fell to within the guidelines at months 10-12.

During the 12 months of lanthanum carbonate treatment, patients had a mean serum albumin level of 3.78 g/dL, suggesting that their nutritional status was maintained.

The observed decrease in phosphorus levels is likely attributable to lanthanum carbonate rather than education and counselling because these latter interventions were implemented before the switch to lanthanum carbonate, the researchers noted.

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