Abstract | BACKGROUND: METHODS: Using a 2×2 factorial design, we randomly assigned 16 normophosphataemic CKD stage 3-4 patients to receive a 2-week treatment with either lanthanum carbonate 1000 mg three times daily or placebo, and to ingest a tightly controlled diet containing 750 or 1500 mg of dietary phosphorus daily. We analysed serial measurements of FGF23, parathyroid hormone, serum phosphate and calcium, and 24-h urinary phosphate and calcium excretion using repeated-measures analyses. RESULTS: Compared with the 1500-mg phosphorus diet, patients assigned to the 750-mg diet had greater reduction in 24-h urinary phosphate excretion (66% vs. 29%; P<0.0001). Lanthanum-treated patients experienced a significant reduction in 24-h urinary phosphate excretion compared with baseline (64%; P<0.0001), but the difference compared with placebo did not reach significance (64% vs. 31%). Despite the significant reductions in 24-h urinary phosphate excretion, no group demonstrated a significant reduction in FGF23 levels; FGF23 levels actually increased significantly in the 1500-mg diet plus placebo group, suggesting dietary phosphorus loading. CONCLUSIONS: Although dietary phosphorus restriction and lanthanum lowered urinary phosphate excretion consistent with a rapid decrease in phosphorus absorption, inducing a reduction in FGF23 levels in CKD patients may require interventions with a longer duration than in healthy volunteers.
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Authors | Tamara Isakova, Orlando M Gutiérrez, Kelsey Smith, Michael Epstein, Leigh K Keating, Harald Jüppner, Myles Wolf |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 26
Issue 2
Pg. 584-91
(Feb 2011)
ISSN: 1460-2385 [Electronic] England |
PMID | 20631407
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Chelating Agents
- FGF23 protein, human
- Phosphorus Compounds
- Phosphorus, Dietary
- lanthanum carbonate
- Fibroblast Growth Factors
- Lanthanum
- Fibroblast Growth Factor-23
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Topics |
- Aged
- Chelating Agents
(therapeutic use)
- Fibroblast Growth Factor-23
- Fibroblast Growth Factors
(metabolism)
- Humans
- Kidney Failure, Chronic
(diet therapy, drug therapy)
- Lanthanum
(therapeutic use)
- Middle Aged
- Phosphorus Compounds
(metabolism)
- Phosphorus, Dietary
- Pilot Projects
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