Impact of switching from lanthanum carbonate to tenapanor on CKD‒MBD management

Abstract

Because strict control of the serum phosphate (P) concentration using the intestinal Na/H exchanger 3 inhibitor (tenapanor) is expected, this retrospective study was performed involving 27 maintenance hemodialysis patients who switched from lanthanum carbonate to tenapanor and did not meet the exclusion criteria at the time. Twelve patients (44.4％) dropped out due to diarrhea, and 5 patients who eventually met the exclusion criteria were excluded, resulting in 10 patients for analysis. The dose of phosphate‒reducing drugs decreased from 4.6±1.9 tablets at the start to 2.4±0.9 tablets after 12 weeks (p＜0.01). The level of serum P decreased from 5.4±0.9 mg/dL at the start to 4.2±0.5 mg/dL after 8 weeks (p＜0.05), and to 3.9±0.9 mg/dL after 10 weeks (p＜0.01). In addition, the final dose of tenapanor was 29.0±13.7 mg/day. Switching from lanthanum carbonate to tenapanor improved control of the serum P concentration and polypharmacy. However, it is important to promote tolerability through patient education because diarrhea occurred at a high rate, even at the starting dose.