Time to Reconsider Calcium-Based Phosphate Binders in Dialysis? A Call for a Well-Designed Randomized Controlled Trial

Jovanovich, Anna

doi:10.1053/j.ajkd.2019.08.008

Cited by 2 publications

(2 citation statements)

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“…Calcium phosphate binders were considered as the first option to treat hypocalcemia accompanying hyperphosphatemia, adding a non-calcium containing phosphate binder is the choice to control the adverse effect of progression of vascular calcification in hemodialysis patients who are only taking calcium carbonate prescribed in higher doses. 21,22 The level of knowledge reported by our study was similar to what has been reported previously. 19 The possible reasons for patients' superficial knowledge on phosphate dietary control and phosphate binders include patients' difficulty in understanding the complexity of the role of minerals and electrolytes, and their interactions in the body.…”

Section: Discussionsupporting

confidence: 91%

Phosphate binders usage, patients knowledge, and adherence

Aleidi

Alayed

Alduraibi

et al. 2020

SMJ

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To assess phosphate binders' usage, knowledge regarding their utilization, and adherence among hemodialysis patients in Qassim, Saudi Arabia. Methods: A prospective cross-sectional study conducted at 4 dialysis centers in Qassim, Saudi Arabia with inclusion of 237 patients' undergoing hemodialysis between November 2018 to January 2019. The study involved interviewing the patients, reviewing their Original Article medical records for biomarkers used to assess kidney function, and assessing the patients' knowledge-based regarding dietary phosphate control, as well as adherence to phosphate binders' usage. Results: Out of 237 included patients, male to female ratio was 54:46. The prevalence of prescribing noncalcium phosphate binders was 82.7% whereas prescribing calcium phosphate binders was 73.8%. A total of 63% of patients showed a medium level of adherence to phosphate binders. Although adherence level was not poor, therapeutic efficacy was affected by other factors such as administration time adherence positively correlated with the serum phosphate level)p=0.00(. Conclusion: Phosphate binders usage is frequent among hemodialysis patients in Qassim centers. Circulating phosphate level was affected by the extent of patients' knowledge of dietary control and adherence to the usage of phosphate binders. Thus, we recommend enhancing patient education in reference to high-and lowphosphate-rich diet to take wise dietary decisions, lower pill burden, and improve adherence toward the control of hyperphosphatemia

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Section: Discussionsupporting

confidence: 91%

Phosphate binders usage, patients knowledge, and adherence

Aleidi

Alayed

Alduraibi

et al. 2020

SMJ

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“…The appropriate use of calcium-based phosphate binders has the potential to reduce health care expenditures because of its low cost and high tolerability . This study demonstrates the need for an RCT among diverse patient populations to determine whether environmental, ethnic, or racial differences contribute to differences in the effects of lanthanum carbonate vs calcium carbonate.…”

Section: Discussionmentioning

confidence: 93%

Effect of Treating Hyperphosphatemia With Lanthanum Carbonate vs Calcium Carbonate on Cardiovascular Events in Patients With Chronic Kidney Disease Undergoing Hemodialysis

Ogata

Fukagawa

Hirakata³

et al. 2021

JAMA

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IMPORTANCE Among patients with hyperphosphatemia undergoing dialysis, it is unclear whether non-calcium-based phosphate binders are more effective than calcium-based binders for reducing cardiovascular events. OBJECTIVE To determine whether lanthanum carbonate reduces cardiovascular events compared with calcium carbonate in patients with hyperphosphatemia at risk of vascular calcification undergoing hemodialysis. DESIGN, SETTING, AND PARTICIPANTSOpen-label, randomized, parallel-group clinical trial with blinded end point adjudication performed in 2374 patients with chronic kidney disease from 273 hemodialysis facilities in Japan. Eligible patients had hyperphosphatemia and 1 or more risk factors for vascular calcification (ie, Ն65 years, postmenopausal, diabetes). Enrollment occurred from November 2011 to July 2014; follow-up ended June 2018.INTERVENTIONS Patients were randomized to receive either lanthanum carbonate (n = 1154) or calcium carbonate (n = 1155) and titrated to achieve serum phosphate levels of between 3.5 mg/dL and 6.0 mg/dL. MAIN OUTCOMES AND MEASURESThe primary outcome was a composite cardiovascular event (cardiovascular death, nonfatal myocardial infarction or stroke, unstable angina, transient ischemic attack, or hospitalization for heart failure or ventricular arrhythmia). Secondary outcomes included overall survival, secondary hyperparathyroidism-free survival, hip fracture-free survival, and adverse events. RESULTS Among 2309 randomized patients (median age, 69 years; 40.5% women), 1851 (80.2%) completed the trial. After a median follow-up of 3.16 years, cardiovascular events occurred in 147 of 1063 patients in the lanthanum calcium group and 134 of 1072 patients in the calcium carbonate group (incidence rate, 4.80 vs 4.30 per 100 person-years; difference 0.50 per 100 person-years [95% CI, −0.57 to 1.56]; hazard ratio [HR], 1.11 [95%, CI, 0.88 to 1.41], P = .37). There were no significant differences in all-cause death (difference, 0.43 per 100 person-years [95% CI, −0.63 to 1.49]; HR, 1.10 [95% CI, 0.88 to 1.37]; P = .42) or hip fracture (difference, 0.10 per 100 person-years [95% CI, −0.26 to 0.47]; HR, 1.21 [95% CI, 0.62 to 2.35]; P = .58). The lanthanum carbonate group had an increased risk of cardiovascular death (difference, 0.61 per 100 person-years [95% CI, 0.02 to 1.21]; HR, 1.51 [95% CI, 1.01 to 2.27]; P = .045) and secondary hyperparathyroidism (difference, 1.34 [95% CI, 0.49 to 2.19]; HR, 1.62 [95% CI, 1.19 to 2.20]; P = .002). Adverse events occurred in 282 (25.7%) in the lanthanum carbonate group and 259 (23.4%) in the calcium carbonate groups.CONCLUSIONS AND RELEVANCE Among patients undergoing hemodialysis with hyperphosphatemia and at least 1 vascular calcification risk factor, treatment of hyperphosphatemia with lanthanum carbonate compared with calcium carbonate did not result in a significant difference in composite cardiovascular events. However, the event rate was low, and the findings may not apply to patients at higher risk.

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Time to Reconsider Calcium-Based Phosphate Binders in Dialysis? A Call for a Well-Designed Randomized Controlled Trial

Abstract: is supported by a VA CDA2 Award (CX001030) and received study drug (lanthanum carbonate) from Shire.

Cited by 2 publications

References 16 publications

Phosphate binders usage, patients knowledge, and adherence

Phosphate binders usage, patients knowledge, and adherence

Effect of Treating Hyperphosphatemia With Lanthanum Carbonate vs Calcium Carbonate on Cardiovascular Events in Patients With Chronic Kidney Disease Undergoing Hemodialysis

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