Prescrire Int. 2007 Apr;16(88):47-50.
(1) In dialysis patients with chronic renal failure, hyperphosphataemia can cause osteorenal dystrophy, leading to bone pain, fractures and excess cardiovascular mortality. In addition to a low-phosphorus diet and dialysis, phosphorus chelators are usually needed to control blood phosphorus levels. The first choice is calcium carbonate, and sevelamer is an alternative. (2) Lanthanum carbonate, a phosphorus chelator, is now also licensed for the treatment of hyperphosphataemia in dialysis patients with chronic renal failure. (3) In addition to three dose-finding placebo-controlled studies, clinical evaluation includes 2 comparative randomised unblinded trials: one 6-month trial versus calcium carbonate and a 2-year trial versus other phosphorus chelators. During these trials, lanthanum was no more effective than the comparators in terms of effects on the mortality rate, incidence of fractures, or blood phosphorus level. (4) During these trials, adverse events attributed to treatment were more frequent with lanthanum than with the other phosphorus chelators. The main problems were gastrointestinal disorders (nausea, vomiting, diarrhoea, constipation and abdominal pain), headaches, seizures, and encephalopathy. (5) The accumulation of lanthanum in the bones and brain is troubling. The known long-term adverse effects of aluminium, another trivalent cation with weak gastrointestinal absorption, suggest that caution is also required with lanthanum. (6) In practice, when a phosphorus chelator is needed to treat hyperphosphataemia in dialysis patients with chronic renal failure, calcium carbonate is the first choice and sevelamer remains the best alternative.
（1）在慢性肾衰竭的透析患者中，高磷血症可导致骨肾性营养不良，引发骨痛、骨折以及心血管疾病死亡率增加。除了低磷饮食和透析外，通常还需要使用磷螯合剂来控制血磷水平。首选是碳酸钙，司维拉姆是一种替代药物。（2）碳酸镧作为一种磷螯合剂，目前也已获批用于治疗慢性肾衰竭透析患者的高磷血症。（3）除了三项剂量探索性安慰剂对照研究外，临床评估还包括两项比较性随机非盲试验：一项为期6个月的与碳酸钙对比试验以及一项为期2年的与其他磷螯合剂对比试验。在这些试验中，就对死亡率、骨折发生率或血磷水平的影响而言，碳酸镧并不比对照药物更有效。（4）在这些试验中，与其他磷螯合剂相比，碳酸镧所致的不良事件更为频繁。主要问题包括胃肠道疾病（恶心、呕吐、腹泻、便秘和腹痛）、头痛、癫痫发作和脑病。（5）碳酸镧在骨骼和大脑中的蓄积令人担忧。另一种胃肠道吸收较弱的三价阳离子铝的已知长期不良影响表明，使用碳酸镧也需要谨慎。（6）在实际应用中，当需要使用磷螯合剂治疗慢性肾衰竭透析患者的高磷血症时，碳酸钙是首选，司维拉姆仍然是最佳替代药物。
