Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis: No adverse effects of lanthanum carbonate compared with standard phosphate-binder therapy

• Published in: Kidney international Vol. 71; no. 3; pp. 252 - 259
• Main Authors: Altmann, P., Barnett, M.E., Finn, W.F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2007; Nature Publishing; Elsevier Limited
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; clinical trial; Cognition - drug effects; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Female; Humans; hyperphosphatemia; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Kidneys; Lanthanum - adverse effects; Male; Medical sciences; Middle Aged; mineral metabolism; Nephrology. Urinary tract diseases; phosphate binders; Phosphates - blood; Phosphorus Metabolism Disorders - drug therapy; Phosphorus Metabolism Disorders - etiology; Renal Dialysis - adverse effects; Urinary system involvement in other diseases. Miscellaneous; clinical trial; phosphate binders; mineral metabolism; end-stage renal disease; hyperphosphatemia; Phosphates; Hydroelectrolytic balance disorder; Nephrology; Hemodialysis; Toxicity; Cognition; Standard; Minerals; Inorganic element; Urology; Extrarenal dialysis; Secondary effect; Clinical trial; Carbonates; Lanthanum; Kidney disease; Human; Urinary system disease; Phosphorus; Terminal stage; Chronic kidney disease; Binders; Metabolism; Standards; Metabolic disorder; Clinical stage; Treatment; Renal failure; Hyperphosphatemia; Comparative study
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5001932

Patients with Stage 5 chronic kidney disease who have hyperphosphatemia require treatment with phosphate binders to lower serum phosphorus levels. Existing binders are effective but may be associated with important safety disadvantages. Lanthanum carbonate is a phosphate binder with demonstrated efficacy, safety, and tolerability in clinical trials. Changes in cognitive function were evaluated over time using the Cognitive Drug Research computerized cognitive assessment system (Simple Reaction Time, Digit Vigilance Task, Choice Reaction Time, Numeric Working Memory, and Delayed Picture Recognition) in 360 hemodialysis patients who were enrolled in a 2-year, multicenter, comparative study of lanthanum carbonate versus standard therapy. A decline in cognitive function from baseline was observed in both groups. The deterioration in cognitive function was similar in both the lanthanum carbonate and standard therapy groups. One parameter – Numeric Working Memory – showed a statistically significant between-group difference in favor of lanthanum carbonate (P=0.02). Given the magnitude of the changes, however, and the differences that were observed at baseline between treatment groups, the clinical significance of this difference is doubtful. This study demonstrates that cognitive function deteriorates in hemodialysis patients over a 2-year time period. Use of lanthanum carbonate as a phosphate binder does not adversely affect cognitive function compared with standard therapy.