Lanthanum Gastropathy in Gastrectomy Specimen: A Case Report.

Lanthanum carbonate (LC) is a phosphate binder used in end-stage renal disease (ESRD) with few adverse effects due to poor systemic absorption. Gastrointestinal deposition is likely due to alterations in epithelial permeability from inflammation in ESRD. It is challenging to detect in cases with minimal deposition and may be missed on endoscopy and biopsy. A 36-year-old with ESRD who was evaluated for gastrectomy was found to have LC deposition histologically. Years later, the excised portion had similar findings. This case allows for evaluation of LC gastropathy in a resection specimen, providing the opportunity to showcase its unique pathology features.

Mechanistic study of highly effective phosphate removal from aqueous solutions over a new lanthanum carbonate fabricated carbon nanotube film.

The effective purification of phosphate-containing wastewater is considered as increasingly important. In this study, a highly effective LC-CNT film was developed for efficient phosphate removal. Kinetic results showed that the adsorbent exhibited an improved mass transfer efficiency and a fast adsorption rate during adsorption (reaching 80% and 100% equilibrium adsorption capacity within 175 and 270 min, respectively). Kinetic model analysis suggested that the adsorption was a combined chemical physical process. Isotherm study revealed that the LC-CNT film showed a superior adsorption capacity (178.6 mg/g, estimated from the Langmuir model) with multiple adsorption mechanisms. pH study suggested that surface complexation and ligand exchange played important roles during adsorption, and the adsorbent worked well within the pH range of 3-7 with little La leakage. The ionic strength and competing anions showed little influence on the adsorbent effectiveness except for the carbonate and sulfate ions. The characterization and mechanism study revealed that the phosphate adsorption of the LC-CNT film was controlled by inner-sphere complexation, outer-sphere complexation and surface precipitation. The LC-CNT film also showed excellent regenerability and stability in cycling runs, further demonstrating its potential in industrial applications.

Safety and efficacy of a feed additive consisting of lanthanum carbonate octahydrate for dogs (Porus GmbH).

Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of lanthanum carbonate octahydrate as a zootechnical feed additive for dogs. The additive is already authorised for use in feed for cats. The FEEDAP Panel concluded that the additive lanthanum carbonate octahydrate is safe for adult dogs at the maximum recommended level of 7500 mg/kg complete feed. The additive is not irritant to skin or eyes, is not a skin sensitiser and exposure by inhalation is considered to be unlikely. The Panel also concluded that lanthanum carbonate octahydrate is efficacious in the reduction of phosphorus bioavailability in adult dogs at the minimum inclusion level of 1500 mg/kg complete feed.

Long-term safety of lanthanum carbonate in the real word: a 19-year disproportionality analysis from the FDA Adverse Event Reporting System.

BACKGROUND: Lanthanum carbonate is widely used to manage serum phosphate and calcium levels in end-stage kidney disease (ESKD) patients, yet comprehensive long-term safety data are lacking. This study leverages the FDA Adverse Event Reporting System (FAERS) to assess the extended safety profile of lanthanum carbonate. RESEARCH DESIGN AND METHODS: We analyzed FAERS data (2004-2022) to study the association between lanthanum carbonate and adverse events (AEs). Using MedDRA v25.0, we identified risk signals through System Organ Classes (SOCs) and Preferred Terms (PTs). Disproportionality analyzes quantified lanthanum carbonate-associated AE signals. RESULTS: Among 3,284 reports, 2,466 were primary suspected AEs linked to lanthanum carbonate. Males reported AEs more frequently than females. Patients aged over 64 represented the majority. Median onset time for lanthanum carbonate-related AEs was 146 days. Gastrointestinal disorders were prevalent. We identified 16 new signals, including stress, abnormal hepatic function, cholelithiasis, bile duct stone, gastric cancer, and adenocarcinoma gastric. Stress was notable, particularly in male patients over 65 and those with lower weight. CONCLUSIONS: This study affirms lanthanum carbonate's long-term safety for reducing elevated blood phosphorus levels. While gastrointestinal disorders were common, attention must focus on emerging AEs, particularly stress, especially in elderly patients.

Structural design of La2(CO3)3 loaded magnetic biochar for selective removal of phosphorus from wastewater.

High levels of phosphorus released into the environment can cause eutrophication issues in wastewater, therefore discharge concentrations of such element are regulated in many countries. This study addresses the pressing need for effective phosphorus removal methods by developing a novel La2(CO3)3 and MnFe2O4 loaded biochar composite (LMB). A remarkable adsorption capacity towards the three forms of phosphorus from wastewater, including phosphate, phosphite, and etidronic acid monohydrate (as a representative of organic phosphorus), was exhibited by LMB (88.20, 16.35, and 15.95 mg g-1, respectively). The high saturation magnetization value (50.17 emu g-1) highlighted the easy separability and recyclability of the adsorbent. The adsorption process was well described by the Langmuir isotherm model and the pseudo-second-order kinetic model, which mainly involved chemisorption. Characterization results confirm the effective loading of La2(CO3)3 with ligand exchange and electrostatic attraction identified as the primary mechanisms. Importantly, the LMB demonstrated exceptional selectivity for phosphorus in wastewater samples containing various substances, exhibiting minimal interference from competing ions (Cl-, NO3-, SO42-, and CO32-). These findings enhance the understanding of LMB's application in efficient wastewater phosphorus removal. Holding significant promise in wastewater remediation, the LMB acts as an effective adsorbent, contributing substantially to the prevention and control of various types of phosphorus pollutants, thereby mitigating wastewater eutrophication.

Contrasting effects of a traditional material of polyaluminum chloride and an emerging material of lanthanum carbonate capping on sediment internal phosphorus immobilization.

Polyaluminum chloride (PAC) is a traditional material used for immobilizing sediment internal phosphorus (P) in field-scale experiment. Lanthanum carbonate (LC) is an emerging material which have been used in immobilizing sediment internal P in laboratory. To promote LC in practice, the premise is that it does have advantages over traditional material when used. Herein, a 90-day incubation experiment was conducted comparing the effectiveness and mechanism of LC and PAC capping in controlling sediment internal P. The results of isotherm experiment and XPS analysis indicated that the adsorption mechanism of P onto LC and PAC involved ligand exchange and formation of inner-sphere La/Al-O-P complexes. The incubation experiment revealed that PAC capping was more effective in reducing pore water soluble reactive phosphorus (SRP), exhibiting a reduction of up to 81.32 % but showed a decrease trend. However, LC capping resulted in a reduction of pore water SRP up to 52.84 % and maintained stability. On average, LC and PAC capping reduced SRP flux by 0.27 and 0.32 µg·m-2d-1, respectively relative to the control sediment. Moreover, LC capping facilitated the formation of Fe(III)/Mn(IV) oxyhydroxides, leading to an increased P adsorption, whereas PAC capping facilitated the reduction of Fe(III)/Mn(IV) minerals with P release. Additionally, LC capping resulted in the reduction of a higher ratio of mobile P/TP to stable P forms than PAC capping, as compared to the control. In contrast to PAC capping which converted mobile P to stable NaOH-rP, LC capping transformed mobile P and NaOH-rP into more stable HCl-P and ResP. Both LC and PAC capping caused variations in sediment bacterial communities. Nevertheless, PAC capping heightened the risk of Co, Ni, Cu, and Pb releases in sediment compared to LC capping. In summary, this study suggested that LC capping surpassed PAC capping in immobilizing sediment internal P.

Simultaneous immobilization of sediment internal phosphorus, arsenic and tungsten by lanthanum carbonate capping.

In this study, lanthanum carbonate (LC) was selected as a capping agent to examine its effectiveness in immobilizing sediment internal phosphorus (P), arsenic (As) and tungsten (W). With a 180-day incubation experiment, it was determined that LC capping efficiently reduced the concentrations of soluble reactive P (SRP), soluble As and soluble W in pore water, with the highest reduction rate of 83.39%, 56.21% and 68.52%, respectively. The primary mechanisms involved in the adsorption of P, As and W by LC were precipitation reactions and ligand exchange. Additionally, P, As and W were immobilized by LC capping through the transformation of fractions from mobile and less stable forms to more stable forms. Furthermore, LC capping led to an increase in the Eh value, which promoted the oxidation of soluble Fe (Ⅱ) and soluble Mn. The significantly positive correlation and synchronized variations observed between SRP, soluble As, soluble W, and soluble Fe (II) indicated that the effects of LC on Fe redox played a crucial role in immobilizing sediment internal P, As and W. However, the oxidation of Mn, promoted by LC, played a more significant role in immobilizing sediment internal As than P and W. These effects resulted in LC capping achieving the highest reduction of SRP, soluble As and soluble W flux at 145.22, 22.19, and 0.58 µg m-2d-1. It is of note that LC capping did not lead to an elevated release hazard of Co, Ni, Cu, and Pb, barring Cd. Besides, LC capping did not modify the entire microbial communities in the sediment, but altered the proportional representation of specific microorganisms. Generally, LC has potential as a capping agent capable of simultaneously immobilizing sediment internal P, As and W.

The deposition of lanthanum carbonate may activate macrophages to induce gastrointestinal mucosal injury in patients with chronic kidney disease: an in vitro caco-2/THP-1 macrophage coculture model study.

The aim of this study was to investigate the effect and possible underlying mechanism of La2(CO3)3 deposition on GI mucosal inflammation. Our results showed that La2(CO3)3 can dissolve in artificial gastric fluids and form lanthanum phosphate (LaPO4) precipitates with an average size of about 1 µm. To mimic the intestinal mucosa and epithelial barrier, we established a Caco-2/THP-1 macrophage coculture model and a Caco-2 monoculture model, respectively. Our findings demonstrated that the medium of THP-1 macrophages stimulated by LaPO4 particles can damage the Caco-2 monolayer integrity in the coculture model, while the particles themselves had no direct impact on the Caco-2 monolayer integrity in the monoculture model. We measured values of trans-epithelial electrical resistance and detected images using a laser scanning confocal microscope. These results indicate that continuous stimulation of LaPO4 particles on macrophages can lead to a disruption of intestinal epithelium integrity. In addition, LaPO4 particles could stimulate THP-1 macrophages to secrete both IL-1ß and IL-8. Although LaPO4 particles can also promote Caco-2 cells to secrete IL-8, the secretion was much lower than that produced by THP-1 macrophages. In summary, the deposition of La2(CO3)3 has been shown to activate macrophages and induce damage to intestinal epithelial cells, which may exacerbate inflammation in patients with chronic kidney disease. Therefore, patients taking lanthanum carbonate, especially those with gastrointestinal mucosal inflammation, should be mindful of the potential for drug deposition in the GI system.

Lanthanum carbonate, a potent and selective phosphate binder, is transported and absorbed mainly via M cells in gastrointestinal tract.

This study aimed to investigate the transportation and absorption mechanism of lanthanum carbonate [La2(CO3)3] through the gastrointestinal (GI) tract using in vitro and in vivo models. The results demonstrated that La2(CO3)3 can be dissolved in gastric fluids and precipitated into lanthanum phosphate as the main transformed specie in intestinal fluid. Using Caco-2 cell monoculture and Caco-2/Raji B cell coculture models to simulate the intestinal epithelium and microfold (M) cells, it was found that the amount of lanthanum transported in Caco-2/Raji B coculture model was significantly higher than that in Caco-2 monoculture model (about 50 times higher), indicating that M cells play an important role in the intestinal absorption of La2(CO3)3. Furthermore, oral administration of La2(CO3)3 to Balb/c mice demonstrated that lanthanum can be absorbed by both Peyer's patches (PPs) and non-PPs intestinal epithelium, with a higher amount of absorption in the PPs per unit weight. This finding further confirmed that the lanthanum absorption in GI tract could be mainly due to the contribution of M cells. Meanwhile, the administration of La2(CO3)3 caused a marked lanthanum accumulation in liver, accompanied by the activation of Kupffer cells. This study clarified how La2(CO3)3 is absorbed through the GI tract to enter the body and would be helpful to evaluate its potential biological consequences of accumulation in human beings.

Efficacy of Lanthanum Carbonate and Sevelamer Carbonate as Phosphate Binders in Chronic Kidney Disease-A Comparative Clinical Study.

(1) Background: Hyperphosphatemia is correlated with an increased rate of mortality and morbidity due to cardiovascular diseases in chronic kidney disease (CKD) patients. It can be improved by restricting dietary intake of phosphate and oral phosphate binders, such as lanthanum carbonate and sevelamer carbonate. (2) Objective: To evaluate the clinical efficacy of sevelamer carbonate in comparison to lanthanum carbonate as phosphate binders for the treatment of hyperphosphatemia in CKD patients. (3) Methods: A randomized control comparative clinical study was conducted for one year on 150 CKD patients associated with hyperphosphatemia, divided into two groups, i.e., Group 1 (n = 75) treated with sevelamer carbonate 800 mg thrice daily and Group 2 (n = 75) treated with lanthanum carbonate 500 mg thrice daily. The patients were assessed at the time of enrollment in the study, after three months and after six months from baseline for different parameters, i.e., complete blood count, liver function tests, renal function tests, electrolytes, and serum phosphate level. (4) Results: 150 CKD patients aged 51-60 participated in the study. The mean age of patients was 54 ± 4.6 years, and males (55.71%) were more common than females (44.29%). Hypertension was the common comorbidity in both groups with chronic kidney disease. After six months of treatment, the mean serum phosphate level was significantly decreased from 8.31 ± 0.09 mg/dL to 5.11 ± 0.18 (38%) in Group 1 and from 8.79 ± 0.28 mg/dl to 4.02 ± 0.12 (54%; p < 0.05) in Group 2, respectively. In both groups, no significant difference was found in other parameters such as parathyroid hormone, calcium, uric acid, LFT, RFT, CBC, etc. (5) Conclusion: Lanthanum carbonate is more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia as compared to sevelamer carbonate.

A Novel Method for Detecting Lanthanum Phosphate Deposition in the Gastroduodenal Mucosa Using Fluorescence Microscopy.

Diagnostic utility of fluorescence microscopy for lanthanum phosphate deposition in the gastrointestinal mucosa has not been reported previously. In this study, we comparatively assessed the light, electron, and fluorescence microscopy features of gastroduodenal lanthanum phosphate deposition in 10 patients with deposits in the stomach and 5 patients with deposits in the duodenum. During light microscopy, lanthanum deposits were observed as dark-brown, needle-shaped, or crystalloid structures and pale red amorphous materials. During electron microscopy, the deposited material appeared as bright aggregates. Fluorescence microscopy also revealed lanthanum deposits as bright areas under green, red, and blue filters. The deposits were more easily recognizable on electron and fluorescence microscopy than on light microscopy. Furthermore, during fluorescence microscopy, the green filter provided the most clear visualization of lanthanum phosphate. In conclusion, fluorescence microscopy with a green filter is useful in determining the degree and extent of lanthanum deposition in the gastroduodenal mucosa.

Effect of low-dose lanthanum carbonate on calcium and phosphorus metabolism in Asian Patients with end-stage renal disease, maintenance hemodialysis and hyperphosphatemia.

Objective: This study aimed to examine whether a 12-week small-dose lanthanum carbonate (LaCO3; 500 mg/d) treatment could improve calcium and phosphorus metabolism and parathyroid function in Asian patients with end-stage renal disease (ESRD) under hemodialysis. Methods: This was a prospective observational study of patients treated at our Hospital between 10/2014 and 02/2015. The patients were given 500 mg/d of LaCO3 with lunch for 12 weeks. Results: Baseline and after 12-week treatment serum phosphorus levels were 2.49±0.51 mmol/L and 1.65±0.34 mmol/L (P<0.001). The baseline and after 12-week treatment calcium×phosphorus product were 69.40±17.34 mg2/dL2 and 44.27±9.67 mg2/dL2 (P<0.001). There was no significant difference in serum calcium and iPTH levels from baseline to after 12 weeks treatment (both P>0.05). Fourteen (25.9%) patients developed gastrointestinal adverse reactions to LaCO3 and 10 patients improved after treatment. Conclusion: Far below the 1.5-3.0g/d required by the drug instructions, LaCO3 500 mg/d for 12 weeks can still reduce serum phosphorus level and calcium × phosphorus product, without serum calcium and iPTH levels increase.

Effect of lanthanum carbonate and calcium carbonate on the progression of coronary artery calcification among hemodialysis patients with vascular calcification risk: a randomized controlled trial.

BACKGROUND: Coronary artery calcification (CAC) is predictive of cardiovascular events. We assessed whether a non-calcium-based phosphate binder, lanthanum carbonate (LC), could delay CAC progression compared with a calcium-based phosphate binder, calcium carbonate (CC), in hemodialysis patients. METHODS: This was a subsidiary of the LANDMARK study, which is a multicenter, open-label, randomized control study comparing LC and CC for cardiovascular events among Japanese hemodialysis patients with hyperphosphatemia who were at risk of vascular calcification. Participants were randomly assigned (1:1) to receive LC or CC. The changes in the total Agatston score of CAC 2 years from baseline were the primary outcome. Secondary outcomes included the changes in the total Agatston score at 1 year from baseline and the changes in serum phosphate, corrected calcium, and intact parathyroid hormone concentrations. RESULTS: Of 239 patients, 123 comprised the full analysis set. The median daily drug dose (mg) was 750 [interquartile range (IQR), 750‒1500] in the LC group and 3000 (IQR, 3000‒3000) in the CC group; it remained constant throughout the study period. There was no significant difference in the change in total Agatston score from baseline to 2 years between the LC and CC groups [368 (95% confidence interval, 57-680) in the LC group vs. 611 (105-1118) in the CC group; difference, 243 (- 352-838)]. CONCLUSIONS: LC-based treatment for hyperphosphatemia did not delay CAC for 2 years compared with CC-based treatment in hemodialysis patients with at least one risk factor for vascular calcification.

Sweet Corrosion Inhibition by CO2 Capture.

The most practical and economical way to combat the problems derived from CO2 corrosion (sweet corrosion) is the use of corrosion inhibitors of organic origin. Its main protection mechanism is based on its ability to adsorb on the metal surface, forming a barrier between the metal surface and the aggressive medium. However, despite its excellent performance, its inhibition efficiency can be compromised with the increase in temperature as well as the shear stresses. In this study, the use of an inorganic inhibitor is proposed that has not been considered as an inhibitor of sweet corrosion. The reported studies are based on using LaCl3 as a corrosion inhibitor. Its behavior was evaluated on 1018 carbon steel using electrochemical measurements, such as potentiodynamic polarization curves, open-circuit potential measurements, linear polarization resistance measurements, and electrochemical impedance. The results showed an inhibition efficiency of the sweet corrosion process greater than 95%, and that the inhibition mechanism was different from the classic corrosion process in CO2-free electrolytes. In this case, it was observed that the inhibitory capacity of the La3+ cations is based on a CO2-capture process and the precipitation of a barrier layer of lanthanum carbonate (La2(CO3)3).

Lanthanum carbonate hydroxide/magnetite nanoparticles functionalized porous biochar for phosphate adsorption and recovery: Advanced capacity and mechanisms study.

As the increase of global industrial activities, phosphate from industrial wastes such as sewage sludge has become one of the limiting factors for water eutrophication. Herein, lanthanum carbonate hydroxide (La(CO3)OH)/magnetite (Fe3O4) nanoparticles functionalized porous biochar (La/Fe-NBC) with high phosphate adsorption properties is synthesized through molten salt pyrolysis-coprecipitation-hydrothermal multi-step regulation, and further reveal the related processes and mechanisms. La(CO3)OH functions as active sites for phosphate adsorption, Fe3O4 imparts magnetic properties to the composite substance, also porous biochar (NBC) acts as the carrier to prevent the agglomeration of La(CO3)OH and Fe3O4 nanoparticles. The adsorption process of La/Fe-NBC for phosphate fits to the Pseudo-Second Order and Langmuir model, with the theoretical maximum adsorption capacity up to 99.46 mg P/g. And La/Fe-NBC possesses excellent magnetic field (14.50 emu/g), stability, and selectivity, which enables for efficient multiple recovery and reuse. Mechanistic studies have shown that ligand exchange (inner-sphere complexation) between phosphate and carbonate/hydroxyl groups of La(CO3)OH, and electrostatic attraction play the dominant roles during adsorption process, although susceptible to the solution pH. While co-precipitation is not influenced of pH conditions but with limited contribution to phosphate adsorption. This study may facilitate to optimize the synthesis design of phosphate multi-functional composites for low-carbon and sustainable treatment of industrial phosphate-containing wastes.

Design and optimization of an innovative lanthanum/chitosan bead for efficient phosphate removal and study of process performance and mechanisms.

Presence of excessive phosphorus in surface waters is the main cause for eutrophication. In this study, a lanthanum/chitosan (La/CS) bead was prepared so as to provide a cost-effective solution to the problem. The optimization of bead for the treatment was conducted, leading to the optimal condition: 30 wt% La/CS bead at a dosage of 30 g L-1 (wet weight). A higher phosphate removal around 90% was obtained in pH 4.0-10.0. Most of uptake occurred in the first 2 h and the equilibrium was reached in about 6 h. Coexisting ions of Cl-, [Formula: see text] , [Formula: see text] , and [Formula: see text] had negligible effects on the treatment, while the presence of F- reduced the uptake by 10.39%. The maximum adsorption capacity of 261.1 mg-PO4·g-1 (dried weight) at pH 5.0 was achieved, which is much better than many reported La-based adsorbents. The adsorbed phosphate can be effectively recovered with an alkaline solution. A multi-cycle regeneration-reuse study illustrated that the treated water still met the phosphorus discharge standard. The characterization results demonstrated the disappearance of La(OH)3 and La2(CO3)3 on the bead and the formation of NH3+ … P and La-P groups after the adsorption, indicating the significant roles of ion exchange and electrostatic attraction on the uptake. The excellent performance found in this study clearly indicates that the optimized La/CS bead is promising in the treatment of phosphate and perhaps its recovery for industrial use.

Safety and efficacy of a feed additive consisting of lanthanum carbonate octahydrate (Lanthan One) for cats (Porus GmbH).

Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of lanthanum carbonate octahydrate (Lanthan One) as a zootechnical feed additive for cats. The FEEDAP Panel concluded that lanthanum carbonate octahydrate is safe for cats at the maximum proposed use level of 7,500 mg/kg complete feed. The additive is not irritant to skin or eyes, is not a skin sensitiser and exposure of users by inhalation is considered unlikely. The Panel also concluded that the additive is efficacious as a phosphate binder in adult cats at the minimum proposed conditions of use (1,500 mg/kg complete feedingstuffs).

An open-label phase 2 trial to assess the efficacy, safety and pharmacokinetics of lanthanum carbonate in hyperphosphatemic children and adolescents with chronic kidney disease undergoing dialysis.

BACKGROUND: This study assessed the efficacy, tolerability and pharmacokinetics (PK) of lanthanum carbonate (LC) in hyperphosphatemic children and adolescents with chronic kidney disease (CKD) undergoing dialysis. METHODS: This was a three-part, multicenter, open-label study of LC (oral powder formulation) in patients 10 to < 18 years old with CKD undergoing dialysis. In part 1, the single-dose PK of LC (500 mg, ≤12 years old; 1000 mg, > 12 years old) were summarized. In part 2, patients received calcium carbonate (CC [chewable tablet formulation]) (1500-6500 mg [total daily dose]) followed by LC (powder formulation) (1500-3000 mg [total daily dose]), or LC only (1500-3000 mg [total daily dose]), each for 8 weeks. During part 3, patients received LC (1500-3000 mg [total daily dose]) for up to 6 months. The primary efficacy endpoint was the proportion of LC-treated patients achieving serum phosphorus control after 8 weeks during parts 2 and/or 3, defined as: ≤1.94 mmol/L, < 12 years old; ≤1.78 mmol/L, ≥12 years old. Secondary efficacy endpoints included: the proportion of patients who achieved serum phosphorus control after 8 weeks of treatment with CC followed by 8 weeks of treatment with LC (with a washout period between treatments). The safety of LC and CC was also evaluated. RESULTS: In part 1, 20 patients received a single dose of LC. In part 2, 53 and 51 patients were treated with CC and LC for 8 weeks, respectively. During part 3, 42 patients received LC for up to 6 months. Most patients were white and male. For the primary efficacy endpoint, 50% (17/34) of patients who received LC for 8 weeks during parts 2 and/or 3 achieved serum phosphorus control. After 8 weeks of treatment with CC, 58.8% of patients achieved serum phosphorus control; after a subsequent washout period and 8 weeks of treatment with LC, 70.6% of patients achieved serum phosphorus control. Tmax and t1/2 occurred within 3-8 h and ~ 19 h, respectively; however, variability was observed. LC and CC were generally well tolerated. CONCLUSIONS: These data support the use of LC to manage hyperphosphatemia in pediatric patients with CKD undergoing dialysis. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01696279; EudraCT identifier: 2012-000171-17. Date of registration: 01/10/2012.

Lanthanum Carbonate Opacities-A Systematic Review.

BACKGROUND: Lanthanum carbonate is a phosphate binder used in advanced kidney disease. Its radiopaque appearance has been described in many case studies and case series. Misinterpretation of this phenomenon leads to unnecessary diagnostic tests and procedures. The objectives of this study were to summarize the literature on lanthanum carbonate opacities and present a visual overview. METHODS: A systematic search was conducted using MEDLINE, Embase, and Web of Science. We included all types of studies, including case reports/studies, describing radiological findings of lanthanum carbonate opacities in patients with chronic kidney disease. No filter for time was set. RESULTS: A total of 36 articles were eligible for data extraction, and 33 articles were included in the narrative synthesis. Lanthanum carbonate opacities were most commonly reported in the intestines (26 studies, 73%), stomach (8 studies, 21%), and the aerodigestive tract (2 studies, 6%). The opacities in the intestine were most frequently described as multiple, scattered radiopaque densities, compared with the aerodigestive tract, where the opacities were described as a single, round foreign body. Suspicion of contrast medium or foreign bodies was the most common differential diagnosis. LC opacities in patients with CKD are commonly misinterpreted as foreign bodies or suspect contrast media. CONCLUSIONS: CKD patients treated with LC may have opacities throughout the digestive tract that can vary in appearance. Stopping LC treatment or changing to an alternative phosphate binder prior to planned image studies can avoid diagnostic confusion. If this is not an option, knowledge of the presentation of LC opacities is important.

Mechanisms of orthophosphate removal from water by lanthanum carbonate and other lanthanum-containing materials.

Removing phosphorus (P) from water and wastewater is essential for preventing eutrophication and protecting environmental quality. Lanthanum [La(III)]-containing materials can effectively and selectively remove orthophosphate (PO4) from aqueous systems, but there remains a need to better understand the underlying mechanism of PO4 removal. Our objectives were to 1) identify the mechanism of PO4 removal by La-containing materials and 2) evaluate the ability of a new material, La2(CO3)3(s), to remove PO4 from different aqueous matrices, including municipal wastewater. We determined the dominant mechanism of PO4 removal by comparing geochemical simulations with equilibrium data from batch experiments and analyzing reaction products by X-ray diffraction and scanning transmission electron microscopy with energy dispersive spectroscopy. Geochemical simulations of aqueous systems containing PO4 and La-containing materials predicted that PO4 removal occurs via precipitation of poorly soluble LaPO4(s). Results from batch experiments agreed with those obtained from geochemical simulations, and mineralogical characterization of the reaction products were consistent with PO4 removal occurring primarily by precipitation of LaPO4(s). Between pH 1.5 and 12.9, La2(CO3)3(s) selectively removed PO4 over other anions from different aqueous matrices, including treated wastewater. However, the rate of PO4 removal decreased with increasing solution pH. In comparison to other solids, such as La(OH)3(s), La2(CO3)3(s) exhibits a relatively low solubility, particularly under slightly acidic conditions. Consequently, release of La3+ into the environment can be minimized when La2(CO3)3(s) is deployed for PO4 sequestration.