Background/Aims: Hyperphosphatemia is an important clinical consequence of renal failure, and its multiple adverse systemic effects are associated with significantly increased risks of morbidity and mortality in dialysis patients. Existing oral phosphate binders have not permitted control of serum phosphate within currently accepted guidelines. This study compares lanthanum carbonate with calcium carbonate for control of serum phosphate in hemodialysis patients. Methods: In this European multicentre study, 800 patients were randomised to receive either lanthanum or calcium carbonate and the dose titrated over 5 weeks to achieve control of serum phosphate. Serum levels of phosphate, calcium and parathryoid hormone were followed over the following 20 weeks. Results: Around 65% of patients in each group achieved phosphate control, but in the calcium carbonate group this was at the expense of significant hypercalcemia (20.2% of patients vs. 0.4%). Consequently, calcium x phosphate product tended to be better controlled in the lanthanum group. Conclusion: This 6-month study demonstrates that serum phosphate control with lanthanum carbonate (750–3,000 mg/day) is similar to that seen with calcium carbonate (1,500–9,000 mg/day), but with a significantly reduced incidence of hypercalcemia. Lanthanum carbonate is well tolerated and may be more effective in reducing calcium x phosphate product than calcium carbonate.

Extracorporeal liver support therapies have been used for several decades as a bridging therapy prior to liver transplantation or as an addendum to standard medical therapy. The molecular adsorbent recycling system (MARS) represents a cell‐free, extracorporeal, liver assistance method for the removal of both albumin‐bound and water‐soluble endogenous toxins. The aim of the present study was to evaluate the short‐and long‐term removal capacity and selectivity of the different inbuilt dialysers and adsorption columns (uncoated charcoal, anion exchanger resin). Levels of endogenous toxins and parameters of hepatic synthesis and necrosis were therefore monitored before, during, and after the MARS treatment phase in 10 patients. Moreover, blood and dialysate clearances of urea nitrogen, creatinine, bilirubin and bile acids were determined during a single treatment. The significant increasing time course of total bilirubin blood levels before the start of the treatment could be stopped and reversed in a significant decreasing time course (Linear Mixed Models, P < 0.05). The removal rate of urea nitrogen, bilirubin, and bile acids during a single treatment amounted to 55.5 ± 4.0%, 28.3 ± 3.9%, and 55.4 ± 4.0%(mean ± SEM), respectively. Bile acids and bilirubin were mainly removed by the activated charcoal and anion exchanger column, respectively. The efficacy of removal of albumin‐bound toxins sharply declined early after initiation of the treatment to become negligible after 6 h. In conclusion, both albumin‐bound and water‐soluble toxins are adequately removed by the MARS. Our data suggest that the rate and efficacy of removal of albumin‐bound toxins is related to both the strength of the albumin binding and the saturation of the adsorption columns.

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