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.
ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT). MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0. ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05). ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.
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.