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Effects of Phosphate Binder Therapy on Vascular Stiffness in Early-Stage Chronic Kidney Disease
- Source :
- American Journal of Nephrology. 38:158-167
- Publication Year :
- 2013
- Publisher :
- S. Karger AG, 2013.
-
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.
- Subjects :
- Male
medicine.medical_specialty
medicine.drug_class
Urology
chemistry.chemical_element
Pilot Projects
urologic and male genital diseases
Placebo
Article
Phosphates
Diabetes Complications
chemistry.chemical_compound
Vascular Stiffness
Double-Blind Method
Lanthanum
Risk Factors
Internal medicine
Homeostasis
Humans
Medicine
cardiovascular diseases
Renal Insufficiency, Chronic
Pulse wave velocity
Aged
business.industry
Phosphorus
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
Phosphate binder
Lanthanum carbonate
Treatment Outcome
Endocrinology
chemistry
Cardiovascular Diseases
Nephrology
cardiovascular system
Feasibility Studies
Phosphorus, Dietary
Sclerostin
Female
business
Biomarkers
Hypophosphatemia
medicine.drug
Kidney disease
Subjects
Details
- ISSN :
- 14219670 and 02508095
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- American Journal of Nephrology
- Accession number :
- edsair.doi.dedup.....b6dab7622fa5e2b581f72ca55a9e97c4