Lee Yong Kyu, Choi Hoon Young, Shin Sug Kyun, Lee Ho Yung
Department of Internal Medicine, Nephrology Division, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
Clin Nephrol. 2013 Feb;79(2):136-42. doi: 10.5414/CN107362.
Hyperphosphatemia is a common complication in end-stage renal disease (ESRD) patients. Reducing the serum phosphate level is crucial in management of ESRD.
This study was a randomized prospective study, designed to compare patients with hyperphosphatemia undergoing peritoneal dialysis while taking lanthanum carbonate or calcium carbonate. We divided 72 continuous ambulatory peritoneal dialysis (CAPD) patients whose serum phosphate levels were over 5.6 mg/dl into two groups to receive either lanthanum carbonate or calcium carbonate. Serum calcium, phosphate and PTH levels were examined serially for 24 weeks.
Both lanthanum carbonate and calcium carbonate reduced serum phosphate levels, from 6.79 ± 1.05 to 5.44 ± 1.44 and from 6.31 ± 1.13 to 4.74 ± 0.78 mg/dl, respectively. The calcium × phosphate product level was reduced in the lanthanum carbonate and calcium carbonate groups from 60.23 ± 10.23 to 46.97 ± 16.42 and from 57.92 ± 11.05 to 44.50 ± 7.74 mg2/dl2, respectively. The serum parathyroid hormone (PTH) level in the lanthanum carbonate group did not change significantly compared to baseline during the study, but in the calcium carbonate group, the serum PTH level decreased significantly. Gastrointestinal complications were the main adverse effects of lanthanum carbonate and 11 out of 35 patients dropped out of the study due to this complication.
Lanthanum carbonate was as effective as calcium carbonate in reducing serum phosphate level, and serum PTH level tended to be steadier in the lanthanum carbonate group compared to the calcium carbonate group. Though the ifference was not significant, lanthanum carbonate tended not to elevate serum calcium level in CAPD patients compared to calcium carbonate. The high incidence of gastrointestinal adverse effect in the lanthanum carbonate group will need further evaluation.
高磷血症是终末期肾病（ESRD）患者常见的并发症。降低血清磷水平对ESRD的治疗至关重要。
本研究为随机前瞻性研究，旨在比较接受碳酸镧或碳酸钙治疗的高磷血症腹膜透析患者。我们将72例血清磷水平超过5.6mg/dl的持续性非卧床腹膜透析（CAPD）患者分为两组，分别接受碳酸镧或碳酸钙治疗。连续24周定期检测血清钙、磷和甲状旁腺激素（PTH）水平。
碳酸镧和碳酸钙均可降低血清磷水平，分别从6.79±1.05降至5.44±1.44mg/dl和从6.31±1.13降至4.74±0.78mg/dl。碳酸镧组和碳酸钙组的钙磷乘积水平分别从60.23±10.23降至46.97±16.42mg²/dl²和从57.92±11.05降至44.50±7.74mg²/dl²。研究期间，碳酸镧组血清甲状旁腺激素（PTH）水平与基线相比无显著变化，但碳酸钙组血清PTH水平显著下降。胃肠道并发症是碳酸镧的主要不良反应，35例患者中有11例因该并发症退出研究。
碳酸镧在降低血清磷水平方面与碳酸钙同样有效，与碳酸钙组相比，碳酸镧组血清PTH水平趋于更稳定。虽然差异不显著，但与碳酸钙相比，碳酸镧在CAPD患者中似乎不会升高血清钙水平。碳酸镧组胃肠道不良反应的高发生率需要进一步评估。
