Print Get Citation Citation Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy. AMA Citation Lau K, Chan A. Lau K, & Chan A Lau, Kathleen, and Alex Chan. Non-calcium-based phosphate binders not found to affect arterial stiffness or aortic calcification. 2 Minute Medicine, 10 November 2020. McGraw-Hill, 2020. AccessMedicine. https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=554787§ionid=251782336APA Citation Lau K, Chan A. Lau K, & Chan A Lau, Kathleen, and Alex Chan. (2020). Non-calcium-based phosphate binders not found to affect arterial stiffness or aortic calcification. (2020). 2 minute medicine. McGraw-Hill. https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=554787§ionid=251782336.MLA Citation Lau K, Chan A. Lau K, & Chan A Lau, Kathleen, and Alex Chan. "Non-calcium-based phosphate binders not found to affect arterial stiffness or aortic calcification." 2 Minute Medicine McGraw-Hill, 2020, https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=554787§ionid=251782336. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Non-calcium-based phosphate binders not found to affect arterial stiffness or aortic calcification by Kathleen Lau, Alex Chan Listen +Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission. +1. Non-calcium-based phosphate binders did not affect arterial stiffness or aortic calcification compared to placebo in moderate-to-severe chronic kidney disease. +Evidence Rating Level: 1 (Excellent) +Abnormal phosphate homeostasis is characteristic of chronic kidney disease, with hyperphosphatemia strongly associated with increased arterial stiffness secondary to calcification. Positive phosphate balance may contribute to rising fibroblast growth factor 23 (FGF23) levels. Both high FGF23 levels and arterial stiffness and calcification are associated with worsening kidney function and cardiovascular events and mortality. Although calcium-based phosphate binders are most commonly prescribed to treat hyperphosphatemia, non-calcium-based phosphate binders, like lanthanum carbonate, have been associated with reduced vascular calcification. Consequently, limited trials have described non-calcium-based phosphate binder therapy lowering serum phosphate and FGF23 levels; however, their effects on cardiovascular markers remain unknown. IMPROVE-CKD, or the IMpact of Phosphate Reduction on Vascular Endpoints in CKD, is an investigator-initiated, multicentre, international,double-blinded, placebo-controlled trial. 138 participants with stage 3b-4 CKD (eGFR 15-44mL/min/1.73m2) with normophosphatemia were randomized 1:1 to receive either 500mg lanthanum carbonate or matched placebo three times daily for 96 weeks. By the end of the trial, no significant differences were seen in the primary endpoint, mean pulse wave velocity (PWV), or in abdominal aortic calcification (AAC), serum phosphate, parathyroid hormone, FGF23 levels, or 24-hour urinary phosphate. At baseline, there was a greater proportion of AAC in the lanthanum arm (86% vs 77% in placebo, p=0.23). Serious adverse events occurred at similar rates between the groups (46% lanthanum vs 47% placebo), next to a significantly higher rate of life-threatening events in lanthanum (3% vs 0%, p=0.06). The study cohort in general was at a high cardiovascular risk at baseline, with a high mean PWV level (>10m/s) and a high prevalence of AAC (81%). Advanced arterial stiffness and calcification may have contributed to the lack of effect seen with the intermediate cardiovascular outcomes measured. Achievement of only 57% of target recruitment also led to underpowering of the study. Nevertheless, this is the largest and longest placebo-controlled study of its kind and its results cannot justify treating moderate-to-advanced CKD with phosphate binders to reduce cardiovascular risk in normophosphatemia. Further studies that are adequately powered could target a cohort with positive phosphate balance to assess whether phosphate-lowering therapies would improve patient outcomes. +Click to read the study in JASN +©2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.