Higher Strength Lanthanum Carbonate Provides Serum Phosphorus Control With a Low Tablet Burden and Is Preferred by Patients and Physicians

Mehrotra, Rajnish; Martin, Kévin; Fishbane, Steven; Sprague, Stuart M.; Zeig, Steven; Anger, Michael

doi:10.2215/cjn.04741107

Cited by 40 publications

(25 citation statements)

References 13 publications

(6 reference statements)

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“…The relationship between adherence and pill burden appeared to be nonlinear such that the greatest fall-off in adherence occurred in patients prescribed 12 or more phosphate binder pills per day. It has been shown that lower pill burden is also associated with greater patient satisfaction (20), and thus it seems prudent that patients should not be prescribed more than 12 phosphate binder pills daily. However, the current study only tested associations, and it is unclear if lower pill burden will translate into a higher adherence.…”

Section: Discussionmentioning

confidence: 99%

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Chiu

Teitelbaum²,

Misra³

et al. 2009

Clinical Journal of the American Society of Nephrology

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514

475

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Background and objectives: Dialysis patients have a high burden of co-existing diseases, poor health-related quality of life (HR-QOL), and are prescribed many medications. There are no data on daily pill burden and its relationship to HR-QOL and adherence to therapy.Design, setting, participants, & measurements: Two hundred and thirty-three prevalent, chronic dialysis patients from three units in different geographic areas in the United States underwent a single, cross-sectional assessment of total daily pill burden and that from phosphate binders. HR-QOL, adherence to phosphate binders, and serum phosphorus levels were the three main outcome measures studied.Results: The median daily pill burden was 19; in one-quarter of subjects, it exceeded 25 pills/d. Higher pill burden was independently associated with lower physical component summary scale scores on HR-QOL on both univariate and multivariate analyses. Phosphate binders accounted for about one-half of the daily pill burden; 62% of the participants were nonadherent. There was a modest relationship between pill burden from phosphate binders and adherence and serum phosphorus levels; these associations persisted on multivariate analyses. There was no relationship between adherence and serum phosphorus levels.Conclusions: The daily pill burden in dialysis patients is one of the highest reported to date in any chronic disease state. Higher pill burden is associated with lower HR-QOL. There are many reasons for uncontrolled serum phosphorus levels; increasing the number of prescribed pills does not seem to improve control and may come at the cost of poorer HR-QOL.

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Section: Discussionmentioning

confidence: 99%

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Chiu

Teitelbaum²,

Misra³

et al. 2009

Clinical Journal of the American Society of Nephrology

Self Cite

514

475

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“…30 Studies have also reported improved satisfaction among patients with CKD stage 5 when switched from their existing phosphate binder to one with a lower pill burden. 34,35 Tenapanor, administered once or twice daily in milligram quantities, may provide a means to reduce pill burden and mass in patients with hyperphosphatemia, thereby improving adherence to treatment. As is the case with phosphate binders, patients took the study drug (tenapanor or placebo) with meals in our study.…”

Section: Discussionmentioning

confidence: 99%

Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis

Block

Rosenbaum

Leonsson-Zachrisson

et al. 2017

JASN

110

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Hyperphosphatemia is common among patients with CKD stage 5D and is associated with morbidity and mortality. Current guidelines recommend lowering serum phosphate concentrations toward normal. Tenapanor is a minimally absorbed small molecule inhibitor of the sodium/hydrogen exchanger isoform 3 that functions in the gut to reduce sodium and phosphate absorption. This randomized, double-blind, placebocontrolled trial assessed the effects of tenapanor on serum phosphate concentration in patients with hyperphosphatemia receiving hemodialysis. After a 1-to 3-week washout of phosphate binders, we randomly assigned 162 eligible patients (serum phosphate =6.0 to ,10.0 mg/dl and a 1.5-mg/dl increase from before washout) to one of six tenapanor regimens (3 or 30 mg once daily or 1, 3, 10, or 30 mg twice daily) or placebo for 4 weeks. The primary efficacy end point was change in serum phosphate concentration from baseline (randomization) to end of treatment. In total, 115 patients (71%) completed the study. Mean serum phosphate concentrations at baseline (after washout) were 7.32-7.92 mg/dl for tenapanor groups and 7.87 mg/dl for the placebo group. Tenapanor provided dose-dependent reductions in serum phosphate level from baseline (least squares mean change: tenapanor =0.47-1.98 mg/dl; placebo =0.54 mg/dl; P=0.01). Diarrhea was the most common adverse event (tenapanor =18%-68%; placebo =12%) and frequent at the highest tenapanor doses. In conclusion, tenapanor treatment resulted in statistically significant, dose-dependent reductions in serum phosphate concentrations in patients with hyperphosphatemia receiving hemodialysis. Additional studies are required to clarify the optimal dosing of tenapanor in patients with CKD-related hyperphosphatemia. 28: 193328: -194228: , 201728: . doi: https://doi.org/10.1681 Disorders of mineral metabolism are common among persons with CKD. 1 Impaired kidney function reduces urinary phosphate excretion, the principal mechanism by which normal phosphate balance is maintained. 2 Modulation of tubular reabsorption of phosphate, mediated in large part by parathyroid hormone (PTH) and the phosphatonin fibroblast growth factor 23 (FGF23), allows for maintenance of serum phosphate concentrations within a physiologic range, despite wide variation in phosphate intake on a day to day basis. However, in advanced CKD, dietary phosphate intake generally exceeds excretory capacity; for patients on dialysis, even with dietary phosphate restriction, hyperphosphatemia is almost inevitable without specific treatment. 3 Among patients receiving dialysis, evidence from observational studies, 1,4 retrospective database analyses, 5,6 and to a lesser extent, prospective controlled trials 7,8 has shown that hyperphosphatemia is associated with mortality, 1,4-6 fractures, 5 and cardiovascular disease, including vascular calcification 8 and left ventricular hypertrophy. 7 J Am Soc Nephrol

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“…53,54 Lanthanumun diğer fosfat bağlayıcılara göre en önemli avantajı günlük alınan tablet miktarının azlığıdır. 55 En önemli dezavantajı ise yüksek tedavi maliyetidir. Bununla beraber lanthanum karbonatın uzun dönem güvenliği ile ilgili veriler de az olduğundan hastaların dikkatli takibi yapılmalıdır.…”

Section: -Kalsi̇yum İçermeyen Fosfat Bağlayicilar A) Sevelamer Hidrokunclassified

Hyperphosphatemia Management and Related Problems in Patients with End Stage Renal Disease: Review

Kaya¹,

Sipahi²

2014

Turkiye Klinikleri J Nephrol

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Higher Strength Lanthanum Carbonate Provides Serum Phosphorus Control With a Low Tablet Burden and Is Preferred by Patients and Physicians

Cited by 40 publications

References 13 publications

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis

Hyperphosphatemia Management and Related Problems in Patients with End Stage Renal Disease: Review

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