Effect of switching from sevelamer hydrochloride to lanthanum carbonate on metabolic acidosis in dialysis patients

Abstract

　Treatments for hyperphosphatemia in dialysis patients include dietary therapy and oral administration of phosphate binders; however, it has recently been suggested that oral administration of sevelamer hydrochloride, a phosphate binder, may cause metabolic acidosis. Owing to the decreased supply of sevelamer hydrochloride after the Eastern Japan Great Earthquake Disaster on March 11, 2011, hyperphosphatemia patients switched to another phosphate binder, lanthanum carbonate. Here, we retrospectively evaluated the effect of this medication substitution on metabolic acidosis in patients on maintenance hemodialysis. 32 patients, who underwent maintenance hemodialysis at Nagasaki Kidney Center in Japan, were enrolled in our study and followed to evaluate the effect of switching medication on metabolic acidosis at 3 months after switching from sevelamer hydrochloride to lanthanum carbonate. The mean dose of sevelamer hydrochloride prior to the earthquake disaster was 3 g/day, and the mean dose of lanthanum carbonate thereafter was 0.9 g/day. Three months after the medication was changed, the concentration of bicarbonate ion did not increase significantly (p = 0.186), whereas pH and base excess increased significantly (p = 0.007 and p = 0.036, respectively). In this study, although the HCO₃ - level was not significantly changed, the pH and base excess were significantly increased. Our findings indicate that lanthanum carbonate ameliorates metabolic acidosis.