Lanthanum carbonate versus sevelamer hydrochloride: improvement of metabolic acidosis and hyperkalemia in hemodialysis patients.

Abstract

Sevelamer hydrochloride (SH) has been reported to aggravate metabolic acidosis and hyperkalemia. This study was performed to evaluate acid-base status and serum potassium changes after replacing SH with lanthanum carbonate (LC) in hemodialysis patients. SH was prescribed for 24 weeks in 14 stable hemodialysis patients and replaced by LC in a similar treatment schedule. Laboratory tests, including indices of acid-base status, nutrition, bone/mineral metabolism, and dialysis adequacy, were performed monthly during the study. Dialysate bicarbonate, potassium and calcium concentrations remained constant. Serum bicarbonate and pH rose, and serum potassium dropped significantly under LC. Alkaline phosphatase also decreased significantly under LC. No significant differences were observed in the other studied parameters between the two treatment periods. Control of serum phosphate was similar under both phosphate-binders and no differences were observed in calcium, Ca × P product, CRP, or lipid levels. Dialysis adequacy was constantly kept within K/DOQI target-range. Although full compliance to treatment was reported, three patients on LC complained of gastrointestinal upset and/or a metallic taste, and four had difficulty chewing the LC tablet. LC improves metabolic acidosis and hyperkalemia in hemodialysis patients previously under SH. Although both medications are well-tolerated, the gastrointestinal side-effects appear to occur more frequently with LC; a fact that, together with difficulties in chewing the tablet, may result in decreased compliance.

• Authors: Vassilis Filiopoulos, Ioannis Koutis, Sofia Trompouki, Dimitrios Hadjiyannakos, Dimitrios Lazarou, Dimosthenis Vlassopoulos
• Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy (Ther Apher Dial) Vol. 15 Issue 1 Pg. 20-7 (Feb 2011) ISSN: 1744-9987 [Electronic] Australia
• PMID: 21272248 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2010 The Authors. Therapeutic Apheresis and Dialysis © 2010 International Society for Apheresis.

Chemical References

• Dialysis Solutions
• Polyamines
• lanthanum carbonate
• Lanthanum
• Sevelamer

Topics

• Acidosis (drug therapy)
• Aged
• Dialysis Solutions (therapeutic use)
• Female
• Humans
• Hyperkalemia (drug therapy)
• Kidney Failure, Chronic (therapy)
• Lanthanum (therapeutic use)
• Male
• Middle Aged
• Polyamines (therapeutic use)
• Prospective Studies
• Renal Dialysis
• Sevelamer