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HERO ID
3093063
Reference Type
Journal Article
Title
Effects of Phosphate Binder Therapy on Vascular Stiffness in Early-Stage Chronic Kidney Disease
Author(s)
Seifert, ME; de Las Fuentes, L; Rothstein, M; Dietzen, DJ; Bierhals, AJ; Cheng, SC; Ross, W; Windus, D; Davila-Roman, VG; Hruska, KA
Year
2013
Is Peer Reviewed?
Yes
Journal
American Journal of Nephrology
ISSN:
0250-8095
EISSN:
1421-9670
Volume
38
Issue
2
Page Numbers
158-167
DOI
10.1159/000353569
Web of Science Id
WOS:000323794400008
Abstract
Background/Aims: Cardiovascular disease (CVD) is increased in chronic kidney disease (CKD), and contributed to by the CKD-mineral bone disorder (CKD-MBD). CKD-MBD begins in early CKD and its vascular manifestations begin with vascular stiffness proceeding to increased carotid artery intima-media thickness (cIMT) and vascular calcification (VC). Phosphorus is associated with this progression and is considered a CVD risk factor in CKD. We hypothesized that modifying phosphorus balance with lanthanum carbonate (LaCO3) in early CKD would not produce hypophosphatemia and may affect vascular manifestations of CKD-MBD. Methods: We randomized 38 subjects with normophosphatemic stage 3 CKD to a fixed dose of LaCO3 or matching placebo without adjusting dietary phosphorus in a 12-month randomized, double-blind, pilot and feasibility study. The primary outcome was the change in serum phosphorus. Secondary outcomes were changes in measures of phosphate homeostasis and vascular stiffness assessed by carotid-femoral pulse wave velocity (PWV), cIMT and VC over 12 months. Results: There were no statistically significant differences between LaCO3 and placebo with respect to the change in serum phosphorus, urinary phosphorus, tubular reabsorption of phosphorus, PWV, cIMT, or VC. Biomarkers of the early CKD-MBD such as plasma fibroblast growth factor-23, Dickkopf-related protein 1 (DKK1), and sclerostin Were increased 2- to 3-fold at baseline, but were not affected by LaCO3. Conclusion: Twelve months of LaCO3 had no effect on serum phosphorus and did not alter phosphate homeostasis, PWV, cIMT, VC, or biomarkers of CKD-MBD. Copyright (C) 2013 S. Karger AG, Basel
Keywords
Cardiovascular disease; Chronic kidney disease; Phosphate binders; Vascular calcification; Randomized controlled trials
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