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Effects of Lanthanum Carbonate on Coronary Artery Calcification and Cardiac Abnormalities After Initiating Hemodialysis

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Abstract

It is known that calcium-containing phosphate binders are more closely associated with the progression of vascular calcification than non-calcium-containing phosphate binders. In this study, we investigated the effect of the non-calcium-containing phosphate binder, lanthanum carbonate on the progression of coronary artery calcification and cardiovascular abnormalities compared to that of calcium-containing phosphate binder in chronic kidney disease patients during the early period after initiating hemodialysis. This was a randomized open-label study in which patients were divided into the calcium carbonate or lanthanum carbonate group. We evaluated blood samples, coronary artery calcification using high-resolution computed tomography, and cardiac abnormalities using echocardiography prior to and after initiating hemodialysis. Cardiac dimension and systolic function were significantly improved in the lanthanum carbonate group compared to those in the calcium carbonate group. Although statistically significant differences were not observed in all the patients, only among patients with moderate coronary artery calcification, the changes in coronary artery calcification score at 18 months were significantly smaller in the lanthanum carbonate group than those in the calcium carbonate group. The percent change in coronary artery calcification at 18 months was significantly correlated with the serum fibroblast growth factor 23 levels at 18 months (r = 0.245, P < 0.05). This significant correlation was particularly strong in patients with moderate coronary artery calcification (r = 0.593, P < 0.001). Our study suggests that lanthanum carbonate ameliorates cardiac abnormalities, and may slow coronary artery calcification development in patients with moderate coronary artery calcification, during the early period following hemodialysis initiation.

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Acknowledgements

This study was partly presented at the annual meeting of the European Renal Association–European Dialysis and Transplant Association Congress, 2016. The authors thank the staff of the Kobe University Graduate School of Medicine (Dr Shuhei Watanabe, Dr Kentaro Watanabe, Dr Ken Kitamura, Dr Rie Awata, Dr Mikiko Yoshikawa, Dr Yuriko Yonekura, and Kayo Tsubota) and the following faculties that participated in this study: from Joyo Ejiri Hospital, Dr Kazunari Ejiri; from Akashi medical center, Dr Susumu Sakamoto; from Kohnan Hospital, Dr Akira Fujimori; from Nishiwaki city hospital, Dr Masahide Iwai; and from Chibune Kidney and Dialysis Clinic, Dr Jong-Il Kim.

Funding

This study was funded by Kidney Foundation, Japan (JKFB11-30).

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Authors and Affiliations

  1. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Hideki Fujii, Keiji Kono, Kentaro Nakai, Shunsuke Goto & Shinichi Nishi

  2. Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan

    Tatsuya Nishii & Atsushi Kono

Authors
  1. Hideki Fujii
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  2. Keiji Kono
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  6. Atsushi Kono
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  7. Shinichi Nishi
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Corresponding author

Correspondence to Hideki Fujii.

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Conflict of Interest

This study was partly supported by Bayer Yakuhin Co., and Hideki Fujii and Shinichi Nishi have received a speaker honorarium from Bayer Yakuhin Co. The other authors declare that they have no other conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fujii, H., Kono, K., Nakai, K. et al. Effects of Lanthanum Carbonate on Coronary Artery Calcification and Cardiac Abnormalities After Initiating Hemodialysis. Calcif Tissue Int 102, 310–320 (2018). https://doi.org/10.1007/s00223-017-0347-3

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  • DOI: https://doi.org/10.1007/s00223-017-0347-3

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