Effects of Switch From Sevelamer Hydrochloride to Lanthanum Carbonate on Serum K and Bone Metabolic Turnover

Effects of switch from sevelamer hydrochloride ( S ev) to lanthanum carbonate ( La ) on serum potassium ( K ) and bone metabolic markers in maintenance dialysis patients were examined. A switch from Sev to La was made for 14 dialysis patients (mean dialysis period and age: 65.3 months and 58.5 years old) to examine changes of biochemical and bone metabolic markers after 8 weeks. The Sev dosage immediately before the switch was 1857 ± 1325 mg/day, and the La dosage 8 weeks after the switch was 821 ± 301 mg/day. The serum calcium ( Ca ) level, which was 8.9 mg/dL before the switch, increased to 9.5 mg/dL after the switch ( P  < 0.05) whereas there was no change in the serum phosphorus level ( P levels) or the calcium × phosphorus product. A decrease in the serum K level (4.6 vs. 4.4 mEq/L, P  < 0.05), an increase in the total cholesterol level (131 vs. 142 mg/dL, P  < 0.05), and a decrease in the serum ALP level (334.5 vs. 282 IU/L, P  < 0.05) were observed, but there was no change in the intact parathyroid hormone ( PTH ) level. A significant negative correlation between the HCO3 level and the serum K level before dialysis was observed. These results suggest that a switch from S ev to L a provided a decrease in the serum K level and normalization of bone metabolic markers, which was not mediated by PTH .