The new findings follow a seven-year clinical trial led by a collaboration of kidney disease specialists from Australia, New Zealand and Malaysia as well as The University of Queensland’s Australasian Kidney Trials Network, which is based at TRI.
Co-Principal Investigator, Associate Professor Nigel Toussaint from The Royal Melbourne Hospital, said high phosphate levels are a common problem in kidney disease and are linked to the onset and degree of cardiovascular disease.
“Phosphate binder medication has long been a treatment for high phosphate levels in people with kidney disease, especially those on dialysis,” Associate Professor Toussaint said.
“There was some evidence that phosphate lowering may be effective in reducing risk factors for cardiovascular disease, but there were no adequate studies looking at the effect of lanthanum carbonate on cardiovascular risk factors in people with chronic kidney disease not on dialysis.
“In our clinical trial involving more than 270 patients from 18 hospitals, we found that lanthanum carbonate did not have a beneficial effect on cardiovascular disease indicators such as arterial stiffness or aortic calcification when compared to placebo.”
The study was the largest trial of its kind to look at the effect of lanthanum carbonate, a phosphate binder medication, in people with chronic kidney disease.
Lead New Zealand investigator, Dunedin Hospital Professor Rob Walker, said the results will be critical for nephrologists to determine the best treatment pathways for patients and provide high value care.
“The pill and symptom burden along with the economic impact for people with chronic diseases is very high, and if we can determine that certain treatments provide limited benefit then that is just as important as finding something that works,” Professor Walker said.
Australasian Kidney Trials Network Chair of the Executive Operations Secretariat, Professor Carmel Hawley, said that phosphate binders were known to cause significant side effects to patients.
“While further trials are needed to ensure consistency of the findings and generalisability of the results, in relation to phosphate binders, they are associated with significant side-effects, particularly gastrointestinal, are inconvenient as they have to be taken with meals.”
About 1.7 million Australian adults and 400,000 New Zealanders have chronic kidney disease. Many people have a progressive decline in kidney function, also known as progression of chronic kidney disease, to the point of needing dialysis or kidney transplantation. In Australia and New Zealand, about 3600 people progress to end-stage kidney disease each year. There are more than 15,500 people receiving dialysis.
The IMPROVE-CKD study was sponsored by The University of Queensland, coordinated by the Australasian Kidney Trials Network and funded through research grants from the National Medical and Medical Research Council and Shire International GmbH, a member of the Takeda group of companies, IST-AUS-000108.
The published paper:
Toussaint, Nigel D; Pedagogos, Eugenia; Lioufas, Nicole; Elder, Grahame J; Pascoe, Elaine M; Badve, Sunil V; Valks, Andrea; Block, Geoffrey A; Boudville, Neil; Cameron, James D; Campbell, Katrina L; Chen, Sylvia SM; Faull, Randall J; Holt, Stephen G; Jackson, Dana; Jardine, Meg J; Johnson, David W; Kerr, Peter G; Lau, Kenneth K; Hooi, Lai-Seong; Narayan, Om; Perkovic, Vlado; Polkinghorne, Kevan R; Pollock, Carol A; Reidlinger, Donna; Robison, Laura; Smith, Edward R; Walker, Robert J; Wang, Angela Yee Moon; Hawley, Carmel M; IMPROVE-CKD Trial Investigators. A Randomised Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD). Journal of the American Society of Nephrology 31(11):p 2653-2666, November 2020. DOI: 10.1681/ASN.2020040411