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  • Phosphate handling in CKD-MBD from stage 3 to dialysis and the three strengths of lanthanum carbonate.

Phosphate handling in CKD-MBD from stage 3 to dialysis and the three strengths of lanthanum carbonate.

Expert opinion on pharmacotherapy (2012-10-05)
Mario Cozzolino, Elena Bruschetta, Daniele Cusi, Emanuele Montanari, Maria Enrica Giovenzana, Andrea Galassi
ABSTRACT

High phosphate levels are associated with unfavorable outcomes in ESRD. Recent data suggested that phosphate levels within the normal range are equally associated with poor outcomes in the community and CKD stage 3 - 4. Several concept papers support the potential role of phosphate load as a first-line toxin in the beginning of CKD-MBD processes via the activation of FGF23 cascade. Phosphate load is thereafter involved in the progression of vascular calcification (VC) and bone disorder typical of CKD-MBD. Herein the authors cover the recent evidence on the pathophysiology of phosphate handling through the natural history of CKD, with particular emphasis on FGF23 cascade, its potential surrogate markers, VC and bone disorder. The major characteristics of lanthanum carbonate are therefore discussed, focusing on its potential advantages for the treatment of difficult cases in CKD-MBD. Lanthanum carbonate, being the most potent calcium-free phosphate binder available in clinical practice, could be decisive for those cases where controlling phosphate load is complicated by poor compliance to medications, stubborn high phosphorus intake, extended VC and bone disorders.

MATERIALS
Product Number
Brand
Product Description

Lanthanum, foil, 50x50mm, thickness 0.1mm, as rolled, 99%
Lanthanum, foil, not light tested, 100x100mm, thickness 0.025mm, as rolled, 99%
Lanthanum, foil, not light tested, 25x25mm, thickness 0.025mm, as rolled, 99%
Lanthanum, foil, 100x100mm, thickness 0.125mm, as rolled, 99%
Lanthanum, rod, 50mm, diameter 6.35mm, cast, 99%
Lanthanum, foil, 100x100mm, thickness 0.1mm, as rolled, 99%
Lanthanum, foil, not light tested, 50x50mm, thickness 0.025mm, as rolled, 99%
Lanthanum, foil, 25x25mm, thickness 0.125mm, as rolled, 99%
Lanthanum, foil, 25x25mm, thickness 0.1mm, as rolled, 99%
Lanthanum, rod, 100mm, diameter 6.35mm, cast, 99%
Sigma-Aldrich
Lanthanum, powder, −40 mesh, under oil, 99.9% trace rare earth metals basis
Sigma-Aldrich
Lanthanum, pieces