Effects of Lanthanum Carbonate on Whole-Body Phosphorus and Calcium Balance in Adults With Chronic Kidney Disease and Normophosphatemia
In brief
In 15 adults, lanthanum shifted phosphorus balance from +320 to -131 mg/day
After 12 weeks, adults with stage 3b-4 chronic kidney disease taking lanthanum had lower whole-body phosphorus balance than those taking placebo, averaging -131 versus +320 mg/day; calcium balance was also lower. The small study measured balance during a controlled diet, not clinical outcomes, so whether these changes benefit patients remains unknown.
- Journal
- Kidney medicine (Q1)
- Published
- 12 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Anna Jovanovich, Michel Chonchol, Taylor Struemph, Tyson J Marden, Ester Oh, Zhiying You, et al.
- PMID
- 42831158
- DOI
- 10.1016/j.xkme.2026.101496
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 7 October 2026): Lanthanum carbonate lowered whole‑body phosphorus balance vs placebo
Abstract
RATIONALE & OBJECTIVE: Greater serum phosphorus is associated with cardiovascular disease in those with chronic kidney disease (CKD). However, the utility of phosphorus lowering in nondialysis-requiring CKD is not clear. The effects of noncalcium-based phosphate binders on phosphorus and calcium balance in nondialysis-requiring CKD are unknown. Our objective was to determine phosphorus and calcium balance in normophosphatemic adults with CKD 3b-4 after 12 weeks of treatment with lanthanum carbonate or placebo. STUDY DESIGN: Prospective, randomized, controlled, double-blind clinical trial. SETTING & PARTICIPANTS: A subset of 15 adults with CKD 3b-4 and serum phosphorus levels within normal limits who participated in a 12-week parallel-arm, randomized controlled trial of lanthanum carbonate compared with placebo on vascular function participated in this study extension. INTERVENTION: At the end of 12 weeks, the subset of participants consumed a controlled diet (1,000 mg/day phosphorus and 800 mg/day calcium) for 9 days and continued their randomly assigned study drug (N = 7 lanthanum carbonate, N = 8 placebo). Fasting morning blood samples and all stool and urine were collected during a 48-hour inpatient clinical research center stay at the end of the 9-day controlled diet period. OUTCOMES: Phosphorus and calcium balance (mg/d) were determined by values averaged over the 48 hours inpatient clinical research center admission. RESULTS: Mean age was 65 ± 8 (SD) years, and mean estimated glomerular filtration rate was 38 ± 14 (SD) mL/min/1.73m2. Whole-body phosphorus balance was lower with lanthanum carbonate compared with placebo (-131 ± 163 [SEM] vs 320 ± 141 mg/d, P = 0.05), as was calcium balance (-46 ± 115 [SEM] vs 410 ± 100 mg/d, P = 0.01), corresponding to lower intestinal absorption supported by the fecal calcium and phosphorus and net absorption results. Neither 24-hour urine calcium nor phosphorus output was significantly different between lanthanum carbonate and placebo, but 24-hour urine phosphorus output differed between lanthanum carbonate and placebo but was not significant (388 ± 60 vs 513 ± 56 mg/d, p=0.15). LIMITATIONS: Small sample size. CONCLUSIONS: Twelve weeks of treatment with the noncalcium-based phosphate binder, lanthanum carbonate, may reduce whole-body phosphorus balance as well as calcium balance among adults with stage 3b-4 CKD and normophosphatemia. Whether reduced phosphorus balance or calcium balance with lanthanum carbonate is associated with beneficial clinical outcomes in CKD warrants further investigation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.