Abstracto

Lanthanum carbonate

William F Finn

Hyperphosphatemia is associated with increased mortality in patients with end-stage renal disease. Unfortunately, precise, effective control of serum phosphate levels cannot be achieved by dialysis and regulation of dietary phosphate alone. For most patients, effective, safe and convenient phosphate binders are needed. Preclinical studies demonstrate that the new phosphate binder, lanthanum carbonate, has potent phosphate-binding properties at clinically relevant pH levels, and indicate that almost all the lanthanum phosphate formed passes unchanged through the gut. Plasma levels of lanthanum are limited and noncumulative, and the minimal systemic fraction has nonrenal elimination. Clinical trials show that lanthanum carbonate, taken with food, can effectively control hyperphosphatemia in dialysis patients, and has a well-tolerated safety profile. Side effects are largely gastrointestinal and are generally mild to moderate. Lanthanum carbonate treatment may prove instrumental in achieving the increasingly stringent target serum phosphate levels in patients with end-stage renal disease.