Objective To assess the efficacy and safety of Lanthanum Carbonate for hyperparathyroidism in dialysis patients. Methods We searched MEDLINE (1996 to April 2006); EMBASE (1996 to April 2006); Cochrane Central Register of Controlled Trials (Issue 1, 2006); CBM disc; VIP and CNKI. We also checked the references of relevant studies. Randomized controlled trials (RCTs) comparing Lanthanum Carbonate with placebo and standard therapy were eligible for inclusion. Quality assessment and data extraction were done by two reviewers independently. Meta-analysis was conducted using The Cochrane Collaboration’s RevMan 4.2.8. Results Six RCTs were included. Lanthanum Carbonate was found to be more effective than placebo in treating hyperparathyroidism of dialysis patients (OR 4.74, 95%CI 2.66 to 8.45; Plt;0.0001) and the incidence of all drug-related adverse events was similar between Lanthanum Carbonate and placebo-treated group (OR 1.23, 95%CI 0.74 to 2.04; P=0.42). The meta-analysis also showed that the efficacy of treating hyperparathyroidism of dialysis patients was similar between Lanthanum Carbonate and conventional phosphate binders (OR 0.97, 95%CI 0.74 to 1.27; P=0.81) and the incidence of all drug-related adverse events was also similar (OR 1.29, 95%CI 0.62 to 2.47; P=0.49). However, serum calcium level was lower in the Lanthanum Carbonate group than in the conventional phosphate binders group. Conclusion Lanthanum Carbonate is effective and well-tolerated in treating hyperparathyroidism of dialysis patients with end-stage renal disease(ESRD). The incidence of hypercalcemia induced by Lanthanum Carbonate is significantly lower than that of the conventional phosphate binders. However, more large-scale, randomized, double-blinded trials are required to investigate the long-term safety and efficacy of Lanthanum Carbonate.
目的 观察三种不同血液净化方式[血液透析（HD）、血液透析滤过（HDF）、血液透析+血液灌流（HD+HP）]对维持性血液透析患者高磷血症清除效果。 方法 选择2009年2月－2011年2月行维持性血液透析的48例高磷血症患者为研究对象，所有患者在低钙透析（1.25 mmol/L）的基础，随机分为HD组、HDF组、HD+HP组，每组16例，分别在治疗时及治疗后4周、8周检查钙、磷、钙磷乘积和全段甲状旁腺激素，并观察其变化。 结果 在治疗4周、8周后，HDF组、HD+HP组磷较前均显著下降（P值均＜0.05），两组同时点相比较差异无统计学意义（P＞0.05）；HD组较前血磷无明显变化（P＞0.05）。 结论 HDF、HP清除维持性血液透析患者高磷有显著的效果，而HD效果则不佳。
ObjectiveTo explore the effectiveness and safety of sevelamer carbonate (Renvela) for hyperphosphatemia in patients with end-stage renal disease (ESRD). MethodsESRD patients undergoing renal replacement therapy with hyperphosphatemia in the East District of Qingdao Municipal Hospital from June to November 2013 were randomly divided into two groups. For eight-week treatment course, the trial group was treated with Renvela (initial dose of 800 mg, tid), and the control group was treated with calcium acetate (initial dose of 667 mg, tid). The dose was adjusted every two weeks to achieve serum phosphorus control. Serum levels of phosphorus, adjusted serum calcium, calcium-phosphorus products, intact parathyroid hormone (iPTH), low density lipoprotein cholesterol (LDL-C) and bicarbonate were recorded. Statistical analysis was conducted using SAS 8.2. ResultsA total of 68 ESRD patients were included, 34 patients in each group. After 8-week treatment, serum phosphorus and calcium-phosphorus products significantly decreased in both groups (P < 0.05). There was no significant difference between the Renvela group and the calcium acetate group in the achievement rate of serum phosphorus (43.33% vs. 36.67%), the incidence of hypercalcaemic events (6.67% vs. 13.33%), and the change of serum iPTH content (-0.88±10.34 pg/mL vs.-0.76±19.14 pg/mL), with no significant difference. However, the Renvela group showed significant advantages in the change of serum phosphorus content (-0.65±0.26 mmol/L vs.-0.53±0.22 mmol/L), the change of adjusted serum calcium content (0.01±0.05 vs. 0.09±0.06 mmol/L), the change of calcium-phosphorus products (-1.45±0.61 mmol2/L2 vs.-0.97±0.47 mmol2/L2), the change of LDL-C content (-0.46±0.10 mmol/L vs. 0.02±0.12 mmol/L), and the change of serum bicarbonate content (-1.00±0.29 mmol/L vs. 0.01±0.18 mmol/L), with significant differences. There was no significant difference in the incidence of adverse reactions (14.71% vs. 11.76%) between the two groups (P=1.00), and the main adverse reaction was gastrointestinal reaction. ConclusionRenvela is relatively effective and safe for hyperphosphatemia in ESRD patients.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs. ResultsA total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low. ConclusionAt present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.