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The following is a summary of “Effect of Lanthanum Carbonate on Serum Phosphate, Oxidative Stress, and Vascular Dysfunction in CKD: A Mechanistic Randomized Controlled Trial,” published in the July 2024 issue of Nephrology by Jovanovich et al.
Chronic Kidney Disease (CKD) often leads to vascular endothelial dysfunction and arterial stiffness, which predict cardiovascular disease (CVD). Even normal-range serum phosphorus levels correlate with CVD and mortality in CKD, possibly due to increased oxidative stress.
Researchers conducted a retrospective study investigating how excess phosphorus, even within normal levels, contributes to vascular dysfunction and CVD in CKD.
They conducted a randomized trial comparing lanthanum carbonate, a non-calcium phosphate binder, with a placebo in 54 patients with CKD 3b-4 and normal phosphorus levels to measure vascular function, oxidative stress, and inflammation markers. The primary endpoint was a change in brachial artery flow-mediated dilation (FMDBA) and carotid-to-femoral pulse-wave velocity (cfPWV) at 12 weeks.
The results showed that at 65 years old, participants had an eGFR of 38 mL/min/1.73m2. After 12 weeks, serum phosphorus stayed steady with lanthanum (3.44±0.47 mg/dL vs. 3.44±0.52 mg/dL; P=0.94) but increased with placebo (3.42±0.80 mg/dL vs. 3.74±1.26 mg/dL; P=0.09). Neither group saw changes in FMDBA and cfPWV, FMDBA lanthanum 3.13%±2.87% to 2.73%±2.48% vs. placebo 3.74%±2.86% to 3.09%±2.49%; P=0.67. cfPWV lanthanum 1214±394 cm/sec to 1216±322 cm/sec vs. placebo 993±289 cm/sec to 977±254 cm/sec; P=0.77. Ascorbic acid infusion didn’t affect artery dilation differently. Oxidative stress and inflammation markers were similar between groups.
Investigators concluded that lanthanum carbonate didn’t notably impact vascular function, arterial stiffness, or endothelial oxidative stress markers in CKD 3b-4 patients with normal phosphorus levels.
Source: journals.lww.com/kidney360/abstract/9900/effect_of_lanthanum_carbonate_on_serum_phosphate,.398.aspx
