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Effects of phosphate binder therapy on vascular stiffness in early-stage chronic kidney disease.
Am J Nephrol. 2013; 38(2):158-67.AJ

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.

Authors+Show Affiliations

Division of Pediatric Nephrology, Southern Illinois University, Springfield, Ill., USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23941761

Citation

Seifert, Michael E., et al. "Effects of Phosphate Binder Therapy On Vascular Stiffness in Early-stage Chronic Kidney Disease." American Journal of Nephrology, vol. 38, no. 2, 2013, pp. 158-67.
Seifert ME, de las Fuentes L, Rothstein M, et al. Effects of phosphate binder therapy on vascular stiffness in early-stage chronic kidney disease. Am J Nephrol. 2013;38(2):158-67.
Seifert, M. E., de las Fuentes, L., Rothstein, M., Dietzen, D. J., Bierhals, A. J., Cheng, S. C., Ross, W., Windus, D., Dávila-Román, V. G., & Hruska, K. A. (2013). Effects of phosphate binder therapy on vascular stiffness in early-stage chronic kidney disease. American Journal of Nephrology, 38(2), 158-67. https://doi.org/10.1159/000353569
Seifert ME, et al. Effects of Phosphate Binder Therapy On Vascular Stiffness in Early-stage Chronic Kidney Disease. Am J Nephrol. 2013;38(2):158-67. PubMed PMID: 23941761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of phosphate binder therapy on vascular stiffness in early-stage chronic kidney disease. AU - Seifert,Michael E, AU - de las Fuentes,Lisa, AU - Rothstein,Marcos, AU - Dietzen,Dennis J, AU - Bierhals,Andrew J, AU - Cheng,Steven C, AU - Ross,Will, AU - Windus,David, AU - Dávila-Román,Víctor G, AU - Hruska,Keith A, Y1 - 2013/08/07/ PY - 2013/03/11/received PY - 2013/06/04/accepted PY - 2013/8/15/entrez PY - 2013/8/15/pubmed PY - 2014/3/25/medline SP - 158 EP - 67 JF - American journal of nephrology JO - Am J Nephrol VL - 38 IS - 2 N2 - 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. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/23941761/Effects_of_phosphate_binder_therapy_on_vascular_stiffness_in_early_stage_chronic_kidney_disease_ L2 - https://www.karger.com?DOI=10.1159/000353569 DB - PRIME DP - Unbound Medicine ER -