Is lanthanum carbonate safer and more effective than calcium carbonate for hyperphosphatemia in dialysis patients?
Masafumi Fukagawa
Correspondence Division of Nephrology and Dialysis Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Email fukagawa@med.kobe-u.ac.jp
This article has no abstract so we have provided the first paragraph of the full text.
Control of serum phosphate level is one of the most important therapeutic goals in patients with chronic kidney disease (CKD). Phosphate load has an important role in the development of bone abnormalities, and has been identified as an independent risk factor for mortality in dialysis patients.1 The majority of intestinal phosphate absorption occurs through passive mechanisms that follow concentration gradients. Sodium-dependent transport, which can be inhibited by nicotinamide, makes a smaller contribution to overall uptake. As the excess phosphate removed by standard hemodialysis regimens is not, however, sufficient to restore normal serum phosphate level or systemic balance, minimization of intestinal phosphate absorption is necessary in most dialysis patients. Several phosphate binders have been used for this purpose, including aluminum salts and calcium salts. More recently, sevelamer hydrochloride has been introduced as an effective phosphate binder, use of which is associated with decreased risk of hypercalcemia and vascular calcification than calcium salts.
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