Effect Of Lanthanum Carbonate On Vascular Calcification In Maintenance Hemodialysis Patients

Objective:Chronic kidney disease(CKD)is a growing global public health problem.Epidemiological statistics report found that the incidence of chronic kidney disease in Chinese adults is 10.8%.Based on this assumption,there are approximately 120 million adults in China(≥18 years old suffers from chronic kidney disease.This is a problem that cannot be overlooked.The main complication is hyperphosphatemia.Hyperphosphatemia can induce and promote vascular calcification,resulting in a significant increase in the incidence of cardiovascular disease,and all-cause mortality.According to the latest DOPPS study,about 78% of hemodialysis patients in China have a blood phosphorus level of more than 4.5mg/dl.Compared with other countries,the proportion of patients with serum phosphorus deficiency in China is the highest,and the average serum phosphorus level is 6.2mg/dl.To further explore the effect and possible mechanism of lanthanum carbonate onabdominal aortic calcification(AAC)in maintenance hemodialysis(MHD)patients.Methods:A total of 200 MHD patients were divided into two groups,the lanthanum carbonate(LC)group and the calcium carbonate(CC)group.We campared the serum calcium,phosphorus,calcium-phosphorus products,intact parathyroid hormone(i PTH)levels at baseline and after the treatment for 24 months.Abdominal aortic calcification score(AACS,Kauppila score)was determined by abdominal lateral radiographs.PAD was diagnosed when ABI<0.9.The statistical analysis was performed using SPSS17.0.Results : Age,dialysis age,body mass index,albumin,hemoglobin,low-density lipoprotein,high-density lipoprotein,triglyceride,cholesterol,urea clearance index and other indicators were not statistically significant at baseline(P>0.05).Serum calcium levels were(2.33±0.20)mmol/L and serum phosphorus levels were(2.61±0.53)mmol/L at baseline in LC group.After 24 months of treatment,serum calcium levels were(2.25±0.17)mmol/L,the level of serum phosphorus were(1.38±0.36)mmol/L.Serum calcium and phosphate decreased significantly in LC group after 24 months therapy as compared with those at baseline(P<0.05).In contrast in CC group,Serum calcium levels were(2.32±0.21)mmol/L and serum phosphorus levels were(2.54±0.53)mmol/L at baseline in LC group.After 24 months of treatment,serum calcium levels were(2.49±0.21)mmol/L,the level of serum phosphorus were(1.72±0.44)mmol/L.serum phosphate decreased significantly,serum calcium increased significantly(P<0.05).When comparisons were made between the two groups,serum calcium and phosphate were significantly lower in LC group than in CC group(P<0.05).The AACS showed a significant increase in CC group[(8.31±6.58)at baseline and(12.49±6.89)at study completion,P<0.05],but no significant change was found in LC group [(8.28±7.18)at baseline and(8.79±6.20)at study completion,P>0.05].Changes in AACS were significantly smaller in LC group than in CC group.There was no significant difference in the proportion of PAD between the two groups at baseline and at 12 months after treatment(P>0.05).At 24 months,the proportion of PAD patients in LC group was significantly lower than that in CC group(P<0.05).Conclusions:Compared with calcium carbonate,the level of serum phosphoruscan be reducedby lanthanum carbonateeffectively,and less cause hypercalcemia,more easily improve the level of calcium and phosphorus products in patients,thus delay the development of vascular calcification in MHD patients.