Toida Tatsunori, Fukudome Keiichi, Fujimoto Shouichi, Yamada Kazuhiro, Sato Yuji, Chiyotanda Susumu, Kitamura Kazuo
Chiyoda Hospital, Japan.
Clin Nephrol. 2012 Sep;78(3):216-23. doi: 10.5414/cn107257.
Lanthanum carbonate (LC) is a non-calcium-containing phosphate binder and shows a comparable effect with other phosphate binders on hyperphosphatemia in dialysis patients. LC also contributes to a reduced oral calcium load compared with calcium carbonate (CaC) treatment. However, no crossover studies which compare the influence on serum calcium level between treatments with LC and CaC in hemodialysis (HD) patients have been carried out.
After washout for 2 weeks, 50 patients on HD were randomized (1 : 1) to receive LC or CaC for 3 months. Thereafter, patients underwent a second 2-week washout period and were switched to the alternative binder for the next 3 months. Mineral and bone metabolism markers were measured with the changes of vitamin D doses.
The serum phosphate level showed a similar decrease from baseline to 3 months in both groups. During the study periods, hypercalcemia was observed only in patients taking CaC. The dose of vitamin D analogue was increased more frequently in the patients of the LC group compared with LC group. The iPTH level showed a significant decrease in the CaC group, but not in the LC group. Serum levels of BAP, TRAP5b, and ALP were significantly elevated in the LC group, whereas the FGF-23 level showed a significant decrease.
LC effectively reduced the serum phosphate level (like CaC) and allowed the vitamin D analogue dosage to be increased without hypercalcemia in HD patients. LC is one of the useful phosphate binders without hypercalcemia. (UMIN-CTR registration number: UMIN000002331).
碳酸镧（LC）是一种不含钙的磷结合剂，在透析患者高磷血症治疗中与其他磷结合剂效果相当。与碳酸钙（CaC）治疗相比，LC还能降低口服钙负荷。然而，尚未开展比较LC和CaC治疗对血液透析（HD）患者血清钙水平影响的交叉研究。
经过2周的洗脱期后，50例HD患者被随机（1:1）分为两组，分别接受LC或CaC治疗3个月。此后，患者经历第二个2周洗脱期，然后在接下来的3个月改用另一种结合剂。测量矿物质和骨代谢标志物，并观察维生素D剂量的变化。
两组患者血清磷水平从基线到3个月均有相似程度的下降。在研究期间，仅在服用CaC的患者中观察到高钙血症。与LC组相比，LC组患者更频繁地增加维生素D类似物的剂量。CaC组的iPTH水平显著下降，而LC组则无明显变化。LC组血清BAP、TRAP5b和ALP水平显著升高，而FGF-23水平显著下降。
LC能有效降低血清磷水平（与CaC类似），且在HD患者中可增加维生素D类似物剂量而不引起高钙血症。LC是一种不会导致高钙血症的有效磷结合剂。（UMIN-CTR注册号：UMIN000002331）
