Changes With Lanthanum Carbonate, Calcium Acetate, and Phosphorus Restriction in CKD: A Randomized Controlled Trial.
Changes With Lanthanum Carbonate, Calcium Acetate, and Phosphorus Restriction in CKD: A Randomized Controlled Trial.
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DOI：
10.1016/j.ekir.2018.03.011
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发表时间：
2018-07
影响因子：
6
通讯作者：
Jarmukli N
中科院分区：
文献类型：
--
作者：
Kovesdy CP;Lu JL;Wall BM;Gyamlani G;Naseer A;Wallick A;Han Z;Thomas F;Quarles LD;Jarmukli N
磷稳态异常在慢性肾脏病（CKD）的早期发展。目前尚不清楚其纠正是否会改善非透析依赖性CKD的临床结局。我们对120例估计肾小球滤过率为15 ~ 59 ml/min/1.73 m2和磷稳态异常（血清磷>4.6 mg/dl，甲状旁腺激素[PTH] >70 pg/ml或肾小管磷重吸收[TRP] <80%）的患者进行了随机对照、平行设计的临床试验。患者被随机分配至开放标签碳酸镧组、醋酸钙组和饮食干预组，为期1年。所有患者的共同主要结局为第12个月（与基线相比）生化（血清磷、TRP、PTH、钙、骨特异性碱性磷酸酶[bALP]和成纤维细胞生长因子23 [FGF 23]）和血管参数（冠状动脉钙评分、脉搏波速度和内皮功能障碍）。次要结局是第12个月和基线之间每个参数变化的治疗间差异。所有分析均为意向性治疗。3组的基线特征相似。共有107名患者（89%）完成了12个月的随访。第12个月时差异不显著（与基线相比）除bALP外的任何结局（第12个月与基线相比的中位数[第25，第75]百分位数：13.8 [10.6，17.6] vs. 15.8 [12.1，21.1]，P < .001）和FGF 23（132 [99，216] vs. 133 [86，189]，P = .002）。除醋酸钙能更有效地抑制PTH外，3组所有结局的变化相似（P <0.001）。使用饮食限制或2种不同的磷结合剂限制磷吸收的1年干预导致bALP降低，表明3/4期CKD患者的骨转换改善，但生化或血管参数无其他显著变化。（ClinicalTrials.gov：NCT 01357317）
Abnormal phosphorus homeostasis develops early in chronic kidney disease (CKD). It is unclear if its correction results in improved clinical outcomes in non–dialysis dependent CKD. We conducted a randomized controlled, parallel design clinical trial in 120 patients with estimated glomerular filtration rate 15 to 59 ml/min per 1.73 m2 and abnormal phosphorus homeostasis (serum phosphorus >4.6 mg/dl, parathyroid hormone [PTH] >70 pg/ml or tubular reabsorption of phosphorus [TRP] <80%). Patients were randomized to open-label lanthanum carbonate versus calcium acetate versus dietary intervention over 1 year. The co-primary outcomes were month 12 (vs. baseline) biochemical (serum phosphorus, TRP, PTH, calcium, bone-specific alkaline phosphatase [bALP], and fibroblast growth factor 23 [FGF23]) and vascular parameters (coronary artery calcium score, pulse wave velocity, and endothelial dysfunction) in all patients. Secondary outcomes were between-treatment differences in change for each parameter between month 12 and baseline. All analyses were intention to treat. Baseline characteristics were similar in the 3 groups. A total of 107 patients (89%) completed 12 months of follow-up. Differences were not significant at month 12 (vs. baseline) for any of the outcomes except bALP (median [25th, 75th] percentile at month 12 versus baseline: 13.8 [10.6, 17.6] vs. 15.8 [12.1, 21.1], P < .001) and FGF23 (132 [99, 216] vs. 133 [86, 189], P = .002). Changes for all outcomes were similar in the 3 arms except for PTH, which was suppressed more effectively by calcium acetate (P < .001). A 1-year intervention to limit phosphorus absorption using dietary restriction or 2 different phosphorus binders resulted in decreased bALP suggesting improved bone turnover, but no other significant changes in biochemical or vascular parameters in patients with CKD stage 3/4. (ClinicalTrials.gov: NCT01357317)
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影响因子：
13.6
作者：
Isakova, Tamara;Gutierrez, Orlando M.;Wolf, Myles
通讯作者：
Wolf, Myles
影响因子：
13.6
作者：
Kestenbaum, B;Sampson, JN;Andress, DL
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Andress, DL
影响因子：
13.2
作者：
Palmer, Suetonia C.;Gardner, Sharon;Strippoli, Giovanni F. M.
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Strippoli, Giovanni F. M.
影响因子：
13.6
作者：
Block, Geoffrey A.;Wheeler, David C.;Chertow, Glenn M.
通讯作者：
Chertow, Glenn M.
DOI：
10.1152/ajpgi.00167.2004
发表时间：
2005-03-01
影响因子：
4.5
作者：
Radanovic, T;Wagner, CA;Biber, J
通讯作者：
Biber, J