期刊
HEMODIALYSIS INTERNATIONAL
卷 26, 期 2, 页码 223-233出版社
WILEY
DOI: 10.1111/hdi.12988
关键词
calcium-based phosphate binders; coronary artery calcification; hemodialysis; lanthanum carbonate
资金
- Project of Administration of Traditional Chinese Medicine of Guangdong Province of China [20181126]
- Specific Research Fund for TCM Science and Technology of Guangdong Provincial Hospital of Chinese Medicine [YN2018QL06]
- National Natural Scientific Foundation [81703848, 81703877, 82004135]
- Natural Scientific Foundation of Guangzhou Province [2017A030310123]
- Specific Research Fund for TCM Science and Technology of Guangzhou Provincial Hospital of Chinese Medicine [YN10101915]
Lanthanum carbonate therapy in hemodialysis patients may help slow the progression of coronary artery calcification and left ventricular mass index, reduce serum phosphate, calcium, and FGF23 levels, and decrease the risk of nonfatal cardiovascular events. Further well-designed RCTs are needed for confirmation.
Introduction Coronary artery calcification and cardiac abnormalities are common in hemodialysis patients. The value of lanthanum carbonate over calcium-based phosphate binders in managing the progression of coronary artery calcification is debated. We reviewed all randomized controlled trials (RCTs) comparing the two strategies in these patients. Methods RCTs comparing lanthanum carbonate with calcium-based phosphate binders used in adult hemodialysis patients were identified in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal, and Wanfang databases. Findings Ten RCTs involving 687 patients were suitable for inclusion. Compared with calcium-based phosphate binders, lanthanum carbonate yielded lower coronary artery calcium scores (weighted mean difference, WMD: -74.28, 95% CI: -149.89, 1.33), change in coronary artery calcium scores (WMD: -105.18, 95% CI: -113.83, -96.53), and left ventricular mass index (WMD: -29.95, 95% CI: -54.25, -7.45). Lanthanum carbonate was significantly associated with lower levels of serum phosphate (WMD: -0.18, 95% CI: -0.26, -0.10), calcium (WMD: -0.22, 95% CI: -0.25, -0.20), and fibroblast growth factor 23 (FGF23) (standard mean difference: -3.78, 95% CI: -5.60, -1.96) but not intact parathyroid hormone (WMD: -4.23, 95% CI: -64.12, 55.65). Moreover, a reduced risk of nonfatal cardiovascular events (OR: 0.31, 95% CI: 0.10-0.97) but not all-cause mortality (OR: 1.08, 95% CI: 0.39-3.01) in lanthanum carbonate therapy was observed. Discussion In hemodialysis patients, lanthanum carbonate therapy may impede the progression of coronary artery calcification and left ventricular mass index and lead to reduced serum phosphate, calcium, FGF23, and nonfatal cardiovascular events compared with calcium-based phosphate binders. However, more well-designed RCTs are required for confirmation.
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