A Systematic Review Of Lanthanum Carbonate For Hyperphosphatemia In End-Stage Renal Disease Patients

Background: Hyperphosphatemia,one common complication of ESRD,can cause SHPT,cardia-angiosteosis and so on,and affect the rate of disability and death.Therefore,the key to elevating quality of life of ESRD patients and degrading the rate of disability and death is the prompt and effective prevention and care of hyperphosphatemia.Until now,the mian therapeutic measures of hyperphosphatemia are confining phosphonium intake,sufficent dialysis,phosphate binders intake and parathyroidectomy(PTX).Controling phosphonium intake strictly can result in malnutrition,and routine hemodialysis can not lower phosphonium thoroughly,so phosphate binders are the main combining theraphy that most of ESRD patients adopt. Conventional phosphate binders contain aluminum or calcium,but aluminum accumulates in bone,brain tissue and hemopoietic system,then generates toxicity to them,and the phosphate binders that contain calcium can elevate blood calcium lever,even lead to hypercalcinemia.Therefor people searched for some new phosphate binders that are safe,effective and with less adverse events.Lanthenum Carbonate is one of neotype phosphate binders,which combine with phosphonium in intestinal tract and form Lanthenum Phosphate which has low water-solubility,then eliminate it through intestinal discharge.This study did Meta analysis about clinical RCTs in latest 15 years,which are about the treatment of hyperphosphatemia with Lanthenum Carbonate, aiming at gain the newest evidence about the efficacy and safety of Lanthenum Carbonate treatment.0bjective:To assess the efficacy and safety of lanthanum carbonate for hyperphosphatemia in ESRD patients.Methods:We searched MEDLINE(January1996 to December 2010),Cochrane Central Regiter of Controlled Trials(January1996 to December 2010),CNKI(January 1996 to December 2010),WanFang(January 1996 to December 2010)database for Randomized, controlled trials(RCTs) of hyperphosphatemia treatment of ESRD patients.RCTs comparing lanthan carbonate with placebo or standard therapy got access to inclusion and data analyses were done with The Cochrane Collaboration's RevMan 5.0 software.Results:All of 6 articles were finally included,and 1688 patients were involved;2 article of them was Grade A,3 articles were Grade B and 1 articles were Grade C. The results of Meta analysis showed:Lanthanum Carbonate was more effective in treating hyperphosphatemia, hyperparathyroidism and lowering calcium-phosphorus product than placebo,and it elevated the lever of blood calcium more obviously than placebo(p<0.05);Lanthanum Carbonate was similar with Calcium Carbonate in treating hyperphosphatemia(p>0.05),but elevating the calcium lever and lowering calcium-phosphorus product more predominently(p<0.05).The incidence rate of hypercalcinemia resulted by Lanthanum Carbonate was lower than that of Calcium Carbonate(p<0.05),and the incidence of other drug-related adverse events,which was all higher than placebo(p<0.05),was similar(p>0.05) excluding the rate of vomiting is higher(p<0.05).The disposition of spots on the funnel map was nearly symmetric,which hints the studies brought into had no publication bias.Conclusion:Lanthanum Carbonate is similar with Calcium Carbonate in treating hyperphosphatemia,and more effective than placebo;except the lower incidence rate of hypercalcinemia,the incidence of other drug-related adverse events are similar with Calcium Carbonate excluding the higher rate of vomiting.