고인산혈증을 동반한 혈액 투석 환자에서 란타늄과 칼슘제재의 효과 비교

초록

Purpose:Hyperphosphatemia and renal osteodystrophy increase the mortality and morbidity in chronic kidney disease. We compared the effects of lanthanum carbonate (LC) and calcium carbonate (CC) on phosphate homeostasis and bone bio-markers in hemodialysis patients. Methods:The Korean dialysis patients with serum phosphorus more than 5.6 mg/dL were randomized to LC (n=12) or CC (n=11). Serum calcium, phosphorus, intact PTH, bone alkaline phosphatase, and osteocalcin were checked at regular intervals for 6 months. Results:The reduction of serum phosphorus and calcium x phosphorus product at 24-week (wk) from baseline values was similar in LC and CC groups (Phosphorus: baseline, 7.28±1.04 mg/dL vs 7.41± 1.39 mg/dL, p=NS; at 24-wk, 5.39±1.85 mg/dL vs 5.67±1.43 mg/dL, p=NS) (Calcium x phosphorus product: baseline, 64.5±11.1 mg2/dL2 vs 61.3±11.9 mg2/dL2, p=NS; at 24-wk, 47.9±14.5 mg2/dL2 vs 51.8±14.0 mg2/dL2, p=NS). Despite higher baseline serum calcium levels in LC group, the changes of serum calcium from the baseline at 24-wk were significantly higher in CC group (LC vs CC; 0.23± 0.38 mg/dL vs 0.94±0.87 mg/dL, p<0.05). Bone bio-markers, including iPTH, bone ALP, and osteocalcin, were comparable in 2 groups. However, significant gastrointestinal side effects leading to discontinuing the study were predominantly observed in LC (LC vs CC; n=5/12 vs n=0/11). Conclusion:Compared to calcium carbonate, lanthanum carbonate has similar efficacy to reduce serum phosphorus level, but less tendency to increase serum calcium level. However, the high incidence of gastrointestinal side effects in lanthanum carbonate needs further investigation in its correlation to Korean.

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