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Abstract: PO0373

Effect of Lanthanum Carbonate on Blood Pressure in CKD: The COMBINE TRIAL

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Jamshidian, Mitra, University of California San Diego School of Medicine, La Jolla, California, United States
  • Larive, Brett, Cleveland Clinic, Cleveland, Ohio, United States
  • Gassman, Jennifer J., Cleveland Clinic, Cleveland, Ohio, United States
  • Raphael, Kalani L., University of Utah Health, Salt Lake City, Utah, United States
  • Chonchol, Michel, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Ix, Joachim H., University of California San Diego School of Medicine, La Jolla, California, United States
  • Ginsberg, Charles, University of California San Diego School of Medicine, La Jolla, California, United States

Higher serum phosphate concentrations are associated with vascular calcification, cardiovascular events, and all-cause mortality. Emerging data suggests that higher serum phosphate may also be associated with increased blood pressure (BP). The effect of phosphate-lowering medication on BP has not been studied in a chronic kidney disease (CKD) cohort.


We evaluated patients from the CKD Optimal Management with Binders and Nicotinamide (COMBINE) Trial, a randomized, double-blind, placebo-controlled trial of phosphate binders and/or nicotinamide in patients with eGFR 20-45 ml/min/1.73m2. Our primary end point for this analysis was 12-month change in systolic BP (SBP). Randomization to lanthanum vs non-lanthanum treatment arms was our primary predictor variable. The secondary predictor variable was 24-hour urine phosphate excretion (a marker of dietary phosphate intake).


205 participants underwent randomization. The mean (± SD) baseline age was 69±12 years, eGFR was 32±7 ml/min per 1.73 m2, and SBP was 129±17 mmHg. Over the 12-month trial, compared to the non-lanthanum arms (N=102), SBP in the lanthanum arms (N=103) rose by 5 mm Hg (P value 0.0497) after adjusting for baseline BP, age, sex, baseline eGFR, clinical center and number of antihypertensives over time. Within the lanthanum arms SBP rose by 5 mm Hg (95% CI 1, 9 mm Hg) and diastolic BP rose by 2 mm Hg (95% CI 0.4, 4mm Hg). BP did not change in the non-lanthanum carbonate arms. There was no association between 24-hour urine phosphate excretion and change in BP.


Among trial participants with moderate to severe CKD, randomization to lanthanum carbonate was associated with increased BP. Future studies should determine whether lanthanum carbonate influences absorption of anti-hypertensive medications.

Change in Systolic Blood Pressure in Lanthanum vs Non-Lanthanum Arms


  • NIDDK Support