Comparison of efficacy and adverse effects of sevelamer with lanthanum carbonate on treatment of hyperphosphatemia in patients undergoing peritoneal dialysis

doi:10.16138/j.1673-6087.2023.06.004

Abstract

Abstract:

Objective To investigate the efficacy and adverse effects of different non-calcium-phosphate binders on the treatment of hyperphosphatemia in patients with end-stage kidney disease undergoing peritoneal dialysis. Methods A total of 124 patients with hyperphosphatemia undergoing peritoneal dialysis who were initially treated with non-calcium-phosphate binders agent were enrolled in the Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from May in 2019 to March in 2021. Among them, 61 cases were treated with sevelamer and 63 cases were treated with lanthanum carbonate. Serum phosphorus, serum calcium, parathyroid hormone(PTH), 25-OH-VitD, alkaline phosphatase level and abdominal aortic calcification score (AACS) before and after treatment were compared in sevelamer or lanthanum carbonate treated groups, furthermore, the pill burden and cost were evaluated. Results The median follow-up time was 16.9 (9.0, 27.2) months until the end of October 2021. Serum phosphorus level was (1.70±0.31), (1.52±0.24) and (1.60±0.34) mmol/L at 1st, 3rd and 6th month after treatment, respectively, and significantly decreased than baseline [(2.08±0.31) mmol/L, P<0.05]. After 1 month and 3 months of treatment, the compliance rate in the lanthanum carbonate treated group was higher than that in the sevelamer treated group (27.0% vs 8.2%, P=0.006; 63.5% vs 39.3%, P=0.007); while after 6 months of treatment, there was no significant difference in PTH level and 25-OH-VitD level between sevelam treated group and lanthanum carbonate treated group[324.3 (178.1, 469.7) ng/L vs 304.4 (165.8, 413.3) ng/L, P=0.414; 15.01 (11.98, 22.75) nmol/L vs 20.02 (16.01, 27.19) nmol/L, P=0.376]. There were no significant differences in AACS and cardiac valve calcification score between the two groups before and after treatment. Gastrointestinal side effects such as nausea and vomiting were more common in lanthanum carbonate treated group (15.9% vs 1.6%, P=0.005). Conclusions Compared with sevelamer, lanthanum carbonate has a faster dephosphorization effect and higher initial serum phosphorus compliance rate, but the digestive tract tolerance is poor.

Key words: Noncalcium phosphate binder, Lanthanum carbonate, Sevelamer, Hyperphosphatemia, Peritoneal dialysis

CLC Number:

R459.5

BAO Lingling, HUANG Xiaomin, ZHANG Chunyan, ZHANG Qianying, WANG Zhaohui, XU Tian, REN Hong. Comparison of efficacy and adverse effects of sevelamer with lanthanum carbonate on treatment of hyperphosphatemia in patients undergoing peritoneal dialysis[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(06): 394-399.

Figures/Tables 8

References 20

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项目	治疗前	1个月	3个月	6个月	F	P
血磷（mmol/L）	2.08±0.31	1.70±0.31^1）	1.52±0.24^1）	1.60±0.34^1）	88.327	0.000
校正钙（mmol/L）	2.32±0.20	2.31±0.17	2.33±0.15	2.36±0.16	2.037	0.148

项目	总体（n=124）	司维拉姆组（n=61）	碳酸镧组（n=63）	t/Z/χ²	P
男性[n（%）]	69（55.6）	34（55.7）	35（55.6）	0.000	0.984
年龄（岁）	52±14	51±15	52±14	-0.748	0.456
BMI（kg/m²）	22.72±3.14	22.79±3.02	22.65±3.27	0.252	0.802
透析龄（月）	24.1（6.6，54.8）	27.2（10.2，65.5）	19.5（5.7，44.0）	-1.782	0.075
t-Kt/V	1.95（1.74，2.36）	1.98（1.75，2.42）	1.92（1.72，2.30）	-0.982	0.326
总CCr[mL/（min·1.73m²）]	53.67（46.66，66.31）	52.22（46.20，60.67）	55.32（46.77，73.85）	-1.477	0.140
nPCR	0.927±0.184	0.934±0.158	0.920±0.207	0.449	0.654
血肌酐（μmol/L）	1 038.0（775.0，1 260.8）	1 122.0（907.5，1 265.5）	990.0（730.0，1 257.0）	-1.652	0.099
尿素（mmol/L）	21.3±6.0	21.0±6.1	21.5±6.0	-0.532	0.596
血尿酸（μmol/L）	397.2±88.7	391.6±75.1	402.6±100.5	-0.695	0.488
血红蛋白（g/L）	106.0±18.0	103.6±17.9	108.3±18.0	-1.471	0.144
红细胞（×10¹²/L）	3.49±0.65	3.42±0.67	3.56±0.63	-1.181	0.240
超敏C反应蛋白（mg/L）	1.59（0.74，3.37）	1.78（0.84，4.28）	1.55（0.67，3.16）	-0.625	0.532
前白蛋白（mg/L）	345.6±78.6	346.8±77.6	344.4±80.1	0.170	0.865
白蛋白（g/L）	34.9±5.1	34.6±5.1	35.1±5.1	-0.569	0.570
丙氨酸转氨酶（U/L）	15.0（12.0，21.0）	15.0（12.0，20.0）	15.0（12.0，22.0）	-0.350	0.726
总胆固醇（mmol/L）	4.70±1.17	4.51±1.03	4.89±1.27	-1.816	0.072
甘油三酯（mmol/L）	1.70（1.18，2.09）	1.57（1.19，2.03）	1.74（1.11，2.32）	-0.725	0.468
低密度脂蛋白胆固醇（mmol/L）	2.84±1.01	2.68±0.93	2.98±1.07	-1.654	0.101
高密度脂蛋白胆固醇（mmol/L）	0.99（0.83，1.24）	1.01（0.81，1.27）	0.98（0.83，1.22）	-0.379	0.705
血糖（mmol/L）	5.10（4.55，5.62）	4.95（4.23，5.42）	5.19（4.74，5.69）	-1.788	0.074

项目	治疗前	1个月	3个月	6个月	F	P
血磷（mmol/L）					3.624	0.023
司维拉姆组（n=61）	2.07±0.31	1.82±0.30^1）	1.59±0.24^1）	1.62±0.34^1）
碳酸镧组（n=63）	2.09±0.32	1.60±0.28^1）	1.46±0.22^1）	1.59±0.34^1）
校正钙（mmol/L）					0.452	0.716
司维拉姆组（n=61）	2.35±0.20	2.34±0.18	2.36±0.16	2.38±0.19
碳酸镧组（n=63）	2.29±0.19	2.28±0.16	2.31±0.14	2.35±0.14

项目	治疗前	3个月	6个月	Z	P
PTH（ng/L）				0.667	0.414
司维拉姆组（n=61）	301.6（181.6，492.2）	308.7（120.8，458.0）	324.3（178.1，469.7）
碳酸镧组（n=63）	342.5（206.0，513.4）	243.1（145.1，346.7）	304.4（165.8，413.3）
25-羟维生素D（nmol/L）				0.785	0.376
司维拉姆组（n=61）	21.51（15.63，32.15）	16.62（12.67，31.39）	15.01（11.98，22.75）
碳酸镧组（n=63）	22.03（17.77，29.62）	19.65（16.74，26.55）	20.02（16.01，27.19）
碱性磷酸酶（U/L）				0.477	0.490
司维拉姆组（n=61）	79.0（63.5，97.8）	82.0（68.0，113.0）	86.5（66.8，113.3）
碳酸镧组（n=63）	78.0（57.3，95.0）	77.0（51.0，108.0）	79.5（64.3，104.5）

分组	1个月		χ²	P	3个月		χ²	P
分组	达标	未达标	χ²	P	达标	未达标	χ²	P
司维拉姆组（n=61）	5（8.2）	56（91.8）	7.496	0.006	24（39.3）	37（60.7）	7.236	0.007
碳酸镧组（n=63）	17（27.0）	46（73.0）			40（63.5）	23（36.5）	7.236	0.007