LANDMARK
Trial question
Is lanthanum carbonate superior to calcium carbonate in patients with CKD and hyperphosphatemia undergoing hemodialysis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 2135
2135 patients (864 female, 1271 male).
Inclusion criteria: patients with CKD and hyperphosphatemia undergoing hemodialysis.
Key exclusion criteria: patients undergoing peritoneal dialysis; patients with contraindications to lanthanum carbonate or calcium carbonate; pregnancy.
Interventions
N=1063 lanthanum carbonate (total daily dose of 750-2250 mg PO).
N=1072 calcium carbonate (total daily dose of 3,000 mg PO).
Primary outcome
CV events
13.8%
12.5%
13.8 %
10.4 %
6.9 %
3.5 %
0.0 %
Lanthanum
carbonate
Calcium
carbonate
No significant
difference ↔
No significant difference in CV events (13.8% vs. 12.5%; HR 1.11, 95% CI 0.88 to 1.41).
Secondary outcomes
No significant difference in death from any cause (15% vs. 13.8%; HR 1.1, 95% CI 0.88 to 1.37).
Significant increase in CV death (5.5% vs. 3.6%; HR 1.51, 95% CI 1.01 to 2.27).
Significant increase in patients with secondary hyperparathyroidism (9.9% vs. 6.3%; HR 1.62, 95% CI 1.19 to 2.2).
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with CKD and hyperphosphatemia undergoing hemodialysis, lanthanum carbonate was not superior to calcium carbonate with respect to CV events.
Reference
Hiroaki Ogata, Masafumi Fukagawa, Hideki Hirakata et al. Effect of Treating Hyperphosphatemia With Lanthanum Carbonate vs Calcium Carbonate on Cardiovascular Events in Patients With Chronic Kidney Disease Undergoing Hemodialysis: The LANDMARK Randomized Clinical Trial. JAMA. 2021 May 18;325(19):1946-1954.
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