A Meta - analysis of lanthanum carbonate for hyperphosphatemia in end - stage renal disease

Objective To assess the efficacy and safety of lanthanum carbonate in treatment of hyperphosphatemia in end-stage renal disease（ESRD）. Methods Randomized controlled trails of lanthanum carbonate in treatment of hyperphosphatemia in ESRD patients were searched in the database of MEDLINE,Cochrane Central Register of Controlled Trials, EMBASE, CNKI, Wanfang database. Data extracted from the literatures were analyzed with the Cochrane Collaboration’s RevMan 5.1 software. Results Lanthanum carbonate group was similar with calcium carbonate group in treating hyperphosphatemia[RR=1.00, 95％CI (0.92-1.09), P=0.97], and more effective than placebo [RR=4.69, 95％ CI (2.63 - 8.39), P＜0.01] (intervention dose≤1500 mg) and [RR=18.92, 95％ CI (7.42-48.22), P＜0.01] (intervention dose＞1500 mg). In comparison with calcium carbonate group, the incidence of hypercalcinemia of lanthanum carbonate group was lower [RR=0.06, 95％CI (0.01-0.72), P=0.03],while the incidence of nausea [RR=1.80, 95％CI (0.70-4.64), P=0.22], vomiting [RR=3.94,95％ CI (0.45 - 34.38), P=0.22] and constipation [RR=0.82, 95％ CI (0.49 - 1.37), P=0.45] were similar. The incidence of nausea and vomiting of lanthanum carbonate group were similar with placebo, with lower incidence of constipation [RR=0.19, 95％ CI (0.06-0.59), P＜0.01]. Conclusions The efficacy of lanthanum carbonate in treating hyperphosphatemia is similar with calcium carbonate. The incidence of hypercalcinemia of lanthanum carbonate is lower than that of calcium carbonate, and the incidence of gastrointestinal adverse effect such as nausea, vomiting and constipation are similar with calcium carbonate.