Lanthanum carbonate has proven safe and effective as a first line phosphate binding agent. In particular, a low incidence of gastro-intestinal side effects is a potential advantage over other hypophosphatemic medications.

In this study, 50 patients on haemodialysis (60% male; 81% Caucasian; age:57±15 years; time on dialysis: 4.3±2.6 years;) were studied. All had been treated with sevelamer chloride but displayed significant G-I side effects (n=42) or inability to tolerate “pill burden” (n=8). 17 patients admitted non-concordance. Sevelamer was ceased and lanthanum commenced at a starting dose of 730±124mg thrice daily. Baseline biochemical data was collected, and repeated 3 months following lanthanum commencement.

A significant and clinically relevant fall in serum phosphate levels was seen between baseline and 3 months (2.20±0.55 versus 1.83±0.52mmol/l; p=0.004), an effect unrelated to dietary adherence or dialysis adequacy (assessed by urea kinetic modelling). Percentage of patients with phosphate levels within the range defined by UK Renal Association (RA) standards (1.1-1.8mmol/l) rose from 26% to 60% (p=0.003). Ca-PO4 product fell from 5.24±1.31 to 4.44±1.16mmol2/l2 (p=0.015), and the percentage within RA standard (<4.8mmol2/l2) rose from 42% to 64% (p=0.05). Phosphate binding pill burden fell from 7.1±2.6 to 4.2±1.9 tablets daily (p=0.001).

Serum bicarbonate rose from 22.8±3.1 to 23.5±2.9mmol/l (p=0.04). No change in serum calcium or PTH was seen. No change in calcium-containing phosphate binder or vitamin D analogue dose was undertaken, and calcimimetics were not used.

In summary, lanthanum is an effective hypophosphatemic agent in a clinically challenging group of patients with intolerance and non-concordance to sevelamer.