Effect of lanthanum carbonate on coronary artery calcification and bone mineral density in maintenance hemodialysis patients with diabetes complicated with adynamic bone disease: A prospective pilot study

BACKGROUND: The incidence of adynamic bone disease (ABD) is increasing. Coronary artery calcification (CAC) may be severe in patients with ABD on maintenance hemodialysis (MHD). The aim of this study was to evaluate the effect of lanthanum carbonate (LC) on CAC and bone mineral density (BMD) in MHD patients with diabetes complicated with ABD. METHODS: A total of 92 MHD cases were divided into the calcium carbonate (CC) and LC groups. Primary outcome measure was the changes in the degree of CAC score (CACS) and BMD in forearm from baseline to 12 months. Secondary outcomes included changes in serum markers of CKD-MBD and side-effects. RESULTS: After 12 months, serum levels of calcium, phosphate, FGF23, and MGP were decreased significantly, while iPTH, b-ALP, PINP and β-CTX, and CACS and BMD were increased in LC group compared with those at baseline (P < .05). After 12 months treatment, serum levels of calcium, phosphate, FGF23, and CACS were lowered, while MGP, b-ALP, PINP, β-CTX, BMD, and iPTH were higher in LC group than in CC group. Pearson correlation analyses revealed that BMD in forearm was positively correlated with iPTH and MGP, while negatively with CACS. CACS was positively correlated with serum calcium, phosphate and FGF23, while negatively with serum MGP. Multivariate linear regression revealed changes of BMD in forearm and femoral neck and changes of serum FGF23 were independent influential factors for changes of CACS (P < .05). CONCLUSIONS: In MHD patients with diabetes complicated with ABD, lanthanum carbonate could delay CAC progress, and improve bone transport and bone density.