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Lanthanum carbonate Vs Calcium Carbonate for Hyperphosphatemia: JAMA
Hyperphosphatemia is a significant factor associated with cardiovascular events and all-cause death among patients with chronic kidney disease (CKD). A recent study suggests that lanthanum carbonate-based treatment without calcium-based phosphate binders did not significantly reduce the composite outcome of cardiovascular events in patients with hyperphosphatemia undergoing hemodialysis. The study findings were published in the JAMA on May 18, 2021.
Among patients with hyperphosphatemia undergoing dialysis, it is unclear whether non–calcium-based phosphate binders are more effective than calcium-based binders for reducing cardiovascular events. Therefore, Dr Hiroaki Ogata and his team conducted a study to determine whether lanthanum carbonate reduces cardiovascular events compared with calcium carbonate in patients with hyperphosphatemia at risk of vascular calcification undergoing hemodialysis.
The LANDMARK Trial was a pen-label, randomized, parallel-group clinical trial of 2374 patients with chronic kidney disease from 273 hemodialysis facilities in Japan and 1851 patients completed the trial. The researchers randomized the patients to receive either lanthanum carbonate (n = 1154) or calcium carbonate (n = 1155) and titrated to achieve serum phosphate levels of between 3.5 mg/dL and 6.0 mg/dL. The major outcome assessed was a composite cardiovascular event (cardiovascular death, nonfatal myocardial infarction or stroke, unstable angina, transient ischemic attack, or hospitalization for heart failure or ventricular arrhythmia). They also assessed overall survival, secondary hyperparathyroidism-free survival, hip fracture–free survival, and adverse events.
Key findings of the study were:
- After a median follow-up of 3.16 years, the researchers noted that the cardiovascular events occurred in 147 of 1063 patients in the lanthanum calcium group and 134 of 1072 patients in the calcium carbonate group (incidence rate, 4.80 vs 4.30 per 100 person-years; difference 0.50 per 100 person-years; hazard ratio [HR], 1.11).
- However, they found no significant differences in all-cause death (difference, 0.43 per 100 person-years; HR, 1.10) or hip fracture (difference, 0.10 per 100 person-years; HR, 1.21).
- They noted that the lanthanum carbonate group had an increased risk of cardiovascular death (difference, 0.61 per 100 person-years; HR, 1.51 ) and secondary hyperparathyroidism (difference, 1.34; HR, 1.62).
- They reported 282 (25.7%) adverse events in the lanthanum carbonate group and 259 (23.4%) in the calcium carbonate groups.
The authors concluded, "Among patients undergoing hemodialysis with hyperphosphatemia and at least 1 vascular calcification risk factor, treatment of hyperphosphatemia with lanthanum carbonate compared with calcium carbonate did not result in a significant difference in composite cardiovascular events. However, the event rate was low, and the findings may not apply to patients at higher risk."
For further information:
Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751