Lanthanum Associated Abnormal Liver Function Tests in Patients on Dialysis
Lanthanum Associated Abnormal Liver Function Tests in Patients on Dialysis
Lanthanum (La) is a phosphate binder used in patients on dialysis in the UK. As it has only recently been in use, there are no long-term data about safety of this rare metal in human subjects with renal failure on renal replacement therapy. La has not been previously reported to cause any adverse reactions apart from nausea, sickness, dialysis graft occlusion and abdominal pain. We report here La induced abnormal liver function tests in a male and a female patient of 70 and 44 years old each, on peritoneal dialysis (PD) and haemodialysis (HD) respectively, the first report of such an adverse reaction to this agent.
Chronic kidney disease (CKD) is accompanied by disorders in bone and mineral metabolism, with effects on cardiovascular function and patient survival. In late stages of CKD, dietary modification is insufficient to control serum phosphate levels. Consequently, pharmacological therapy with an oral phosphate-binding agent is required to reduce the absorption of ingested phosphate.
A recent calcium and aluminium free phosphate binding agent approved for use in the UK is a metal based phosphate binder, Lanthanum carbonate. La is a rare-earth trace metal that naturally occurs in monazite sand and coal and is a trivalent cation that acts as a calcium channel blocker.
We report here two cases of oral La induced abnormal liver function tests in patients on dialysis. To the best of our knowledge this is the first such report showing a possible association between oral La and abnormal liver function tests in patients on dialysis.
Abstract and Introduction
Abstract
Lanthanum (La) is a phosphate binder used in patients on dialysis in the UK. As it has only recently been in use, there are no long-term data about safety of this rare metal in human subjects with renal failure on renal replacement therapy. La has not been previously reported to cause any adverse reactions apart from nausea, sickness, dialysis graft occlusion and abdominal pain. We report here La induced abnormal liver function tests in a male and a female patient of 70 and 44 years old each, on peritoneal dialysis (PD) and haemodialysis (HD) respectively, the first report of such an adverse reaction to this agent.
Introduction
Chronic kidney disease (CKD) is accompanied by disorders in bone and mineral metabolism, with effects on cardiovascular function and patient survival. In late stages of CKD, dietary modification is insufficient to control serum phosphate levels. Consequently, pharmacological therapy with an oral phosphate-binding agent is required to reduce the absorption of ingested phosphate.
A recent calcium and aluminium free phosphate binding agent approved for use in the UK is a metal based phosphate binder, Lanthanum carbonate. La is a rare-earth trace metal that naturally occurs in monazite sand and coal and is a trivalent cation that acts as a calcium channel blocker.
We report here two cases of oral La induced abnormal liver function tests in patients on dialysis. To the best of our knowledge this is the first such report showing a possible association between oral La and abnormal liver function tests in patients on dialysis.
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