Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up

Spasovski, Goce; Šikole, Aleksandar; Gelev, Saso; Masin-Spasovska, Jelka; Freemont, Anthony J.; Webster, I.; Gill, Maggie; Jones, Chris; Broe, Marc E. De; D’Haese, Patrick C.

doi:10.1093/ndt/gfl146

Cited by 141 publications

(106 citation statements)

References 28 publications

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“…Eighteen trials 4,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] met the predefined inclusion criteria and were included in our meta-analysis ( Figure 1). The 18 trails included 3676 patients (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Two trials 18,25 provided data about bone histomorphometry (n ¼ 84). The osteoid volume and osteoblast numbers were significantly higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers), with no significant heterogeneity of included trials (p ¼ 0.16, I 2 ¼ 49% for osteoid volume; p ¼ 0.64, I…”

Section: Bone Histomorphometrymentioning

confidence: 99%

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The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

et al. 2014

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Background: Vascular calcification significantly increases the rates of cardiovascular mortality in hemodialysis (HD) patients. Abnormalities in mineral metabolism may play a role in the pathogenesis of arterial calcification. Whether patients treated with non-calcium-based phosphate binders had reduced aortic vascular calcification compared to those treated with calcium-based phosphate binders is still unclear. Methods: We searched multiple databases for studies published through August 2013 that evaluated the effects of non-calcium-based phosphate binders (NCBP) versus calcium-based phosphate binders (CBP) on cardiovascular calcification and bone remodeling among dialysis patients. We summarized test performance characteristics with the use of forest plots, fixed and random effects models, and Egger regression test. Results: Eighteen eligible randomized controlled trials totaling 3676 patients were included. Meta-analysis results showed NCBP could significantly attenuate the progression of coronary artery calcification than CBP (WMD: À144.62, 95% CI: À285.62 to À3.63). The serum calcium levels significant lower in NCPB group than in CPB groups (WMD: À0.26, 95% CI: À0.37 to À0.14), but the serum iPTH levels were significantly higher in NCPB groups (WMD: 57.1, 95% CI: 13.42 to 100.78). The osteoid volume and osteoblast numbers were significant higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers). The Egger regression test also showed no potential publication bias (p ¼ 0.725). Conclusions: Based on available data, NCBPs have equally effective with CBPs for serum phosphate control. But there was significantly lower incidence of coronary artery calcification and a significant higher bone formatting rate in NCBP groups than in CBP groups. So we recommend NCBPs as phosphate binders for HD patients.

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Section: Resultsmentioning

confidence: 99%

Section: Bone Histomorphometrymentioning

confidence: 99%

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

et al. 2014

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“…63 These results were also confirmed by other authors, showing that bone deposition after 1 year of treatment with LC was low, while a slow release of LC was observed after 2 years of follow-up, without evidence of osteomalacia or any forms of bone toxicity. 64 …”

Section: Lanthanum Carbonatementioning

confidence: 99%

Phosphate control in dialysis

Cupisti¹,

Gallieni²,

Rizzo³

et al. 2013

IJNRD

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Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

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“…Secondary analyses of postmenopausal patients with osteoporosis and undiagnosed CKD in randomized, controlled trials of antiresorptive or anabolic agents show efficacy (55-58) compared with placebo (both the treatment and the placebo groups received calcium supplementation). Calcium-based phosphate binders (at doses generally greater than those used in placebo groups of osteoporosis trials) compared with non-calcium-containing phosphate binders did not show improvement in bone histology; some studies demonstrated the development of adynamic bone disease with calcium-based binders (12,(59)(60)(61)(62)(63); further reviewed in 36). No studies have shown that calcium supplement or binder intake improves bone mineral density.…”

Section: Efficacy Of Calcium Binders For Bone Health In the Ckd Populmentioning

confidence: 99%

Calcium Builds Strong Bones, and More Is Better—Correct? Well, Maybe Not

Jamal

Moe

2012

Clinical Journal of the American Society of Nephrology

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SummaryCalcium supplementation has been considered the gold standard therapy for osteoporosis in the general population. It is given in both the placebo and treatment groups of trials evaluating antifracture efficacy of new therapies. Similarly, calcium-based phosphate binders have been considered the gold standard comparator for all new phosphate binders. However, large randomized trials demonstrate conflicting data on the antifracture efficacy of calcium supplementation, particularly in high doses, in patients with osteoporosis without CKD. In addition, recent data suggest an increased risk for cardiovascular events. These new studies raise safety concerns for the general approach with calcium supplementation and binders. This review describes recent data on the adverse effects of calcium supplementation for osteoporosis and how these new data should affect the strategy for phosphate binder use in CKD.

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Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up

Abstract: Bone deposition after 1 year of treatment with LC is low (highest concentration: 5.5 microg/g). There is a slow release of lanthanum from its bone deposits 2 years after the discontinuation of the treatment and no association with aluminium-like bone toxicity.

Cited by 141 publications

References 28 publications

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

Phosphate control in dialysis

Calcium Builds Strong Bones, and More Is Better—Correct? Well, Maybe Not

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