***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction : Uremic toxins play a pivotal role in the development of systemic complications of chronic kidney disease ( CKD ) , which are largely mediated by the activation of the immune system . Triggers of inflammation in CKD are largely unknown and strategies aim ing to reduce circulating lig and s that could start the inflammatory response are potentially important . In the present study , we investigated the impact of sevelamer hydrochloride treatment in reducing endotoxemia and inflammation in a group of hemodialysis ( HD ) patients . Material and Methods : HD patients , who were converted from calcium carbonate treatment to sevelamer according to KDOQI guidelines , were included and prospect ively followed for 6 months . Systemic inflammation was evaluated by serum ultra-high-sensitivity C-reactive protein ( hsCRP ) using an automated immunoturbidimetric assay . Endotoxin was measured using Limulus amebocyte lysate chromogenic endpoint assay . All the analyses were performed immediately before conversion and after 6 months of treatment . Results : After the exclusion of patients discontinuing the treatment , 20 patients ( mean dialysis time 12 ± 4 months on HD , age 52 ± 2 years , 38 % males , 11 % diabetics ) were included in the analysis . No significant changes were observed in Ca , P and PTH levels , while a reduction in cholesterol levels was seen . Plasma concentration of hsCRP and endotoxin significantly decreased after 6 months of conversion to sevelamer compared with baseline . Conclusion : We conclude that sevelamer treatment leads to a decrease in hsCRP levels , which was accompanied by a parallel decrease in endotoxemia , suggesting that endotoxemia may contribute to the systemic inflammation in HD patients , which was partially reduced by the use of sevelamer AIMS No conventional phosphate binder is entirely satisfactory for the treatment of  hyperphosphatemia in patients with end-stage renal disease ( ESRD ) . Consequently , there is a need for new agents . One such agent is lanthanum carbonate ( La ) . This large-scale study compares the safety of La with st and ard therapy ( any approved phosphate binder ) in patients who were treated for up to 2 years . Efficacy , having previously been demonstrated , was a secondary endpoint . MATERIAL S AND METHODS After washout , patients were r and omized to receive La ( n=682 ) or their pre- study phosphate binder ( n=677 ) . Over a 6-week period , La was titrated to a maximum daily dose of 3000 mg elemental lanthanum ( serum phosphorus target levels for titration were < or = 5.9 mg/dl ( 1.90 mmol/l ) ) . Safety assessment s included adverse events ( AEs ) , full laboratory parameters and blood profiles . Efficacy assessment s included serum phosphorus , calcium , calcium x phosphorus product and parathyroid hormone ( PTH ) levels . RESULTS Average treatment exposure was greater in the st and ard therapy group ( 501.4 days ) than in the La group ( 370.3 days ) because st and ard therapy patients who switched or combined treatments were allowed to continue in the study . The most common AEs were gastrointestinal . The incidences of AEs in the La and treatment exposure-corrected st and ard therapy groups were nausea , 37 versus 29 % ; vomiting , 27 versus 22 % and diarrhea ( 24 % in each group ) . Hypercalcemia that was reported as an AE ( La versus treatment exposure-corrected st and ard therapy ) occurred in 4.3 % and 8.4 % of patients , respectively . There was no indication of liver toxicity , suppression of erythropoiesis or changes in the mini-mental state examination . Over 2 years , phosphorus control was similar in both groups ; in the La group , however , serum calcium was lower and serum PTH levels were maintained in the range recommended by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative ( K/DOQI ) . CONCLUSIONS The 2-year tolerability and efficacy of La are similar to those seen with st and ard therapy , although lower serum calcium levels and improved PTH levels were observed in the La group . These results support La as a viable new option for the management of hyperphosphatemia in ESRD AIMS High serum phosphorus levels are a common problem in patients receiving long-term dialysis treatment .  Lanthanum carbonate ( Fosrenol ) is a new non-aluminum , non-calcium phosphate binder developed for the treatment of hyperphosphatemia in patients with end-stage renal disease ( ESRD ) . We report data from a recent trial , which , for the first time , assessed the efficacy and tolerability of lanthanum carbonate treatment , compared with placebo , in Chinese patients with ESRD . PATIENTS AND METHODS Following a one- to three-week washout phase and a four-week , open-label lanthanum carbonate dose-titration phase , male and female hemodialysis patients were r and omized ( 1:1 ) to receive either lanthanum carbonate or placebo for four weeks . The primary efficacy parameter of the study was the control of serum phosphorus levels ( < or = 1.8 mmol/l [ < or = 5.6 mg/dl ] ) . Secondary endpoints included the profile of serum phosphorus during titration and parathyroid hormone , calcium , and calcium x phosphorus ( Ca x P ) product levels . The safety and tolerability of lanthanum carbonate were assessed by monitoring adverse events throughout the study . RESULTS Mean serum phosphorus level at the end of washout was 2.5 + /- 0.5 mmol/l ( 7.7 + /- 1.5 mg/dl ; n=73 ) , and there was no evidence of a difference in levels between the treatment groups pre-r and omization . At the end of the study , lanthanum carbonate-treated patients had significantly lower phosphorus levels ( 1.6 + /- 0.5 mmol/l [ 5.1 + /- 1.5 mg/dl ] ; n=30 ) than those receiving placebo ( 2.3 + /- 0.4 mmol/l [ 7.2 + /- 1.3 mg/dl ] ; n=31 ; p < 0.001 ) . In addition , a significantly higher proportion of patients receiving lanthanum carbonate had controlled serum phosphorus levels ( 60 % ) compared with the placebo group ( 10 % ; p < 0.001 ) . Ca x P product levels were also significantly lower in the lanthanum carbonate group at the end of r and omized treatment ( p < 0.001 ) . Lanthanum carbonate was well tolerated ; only one serious adverse event was reported , which was unrelated to treatment . CONCLUSIONS Lanthanum carbonate was shown to be an effective and well-tolerated phosphate binder for the treatment of hyperphosphatemia in Chinese patients with ESRD . This finding supports the results of previous US and European studies , which have also shown that lanthanum carbonate treatment effectively controls serum phosphorus levels Background : Control of serum phosphate over the long term is essential in patients with end-stage renal disease . Six-month and 2-year extensions to a 6-month study evaluated the long-term safety , tolerability and efficacy of the new phosphate binder lanthanum carbonate . Methods : Patients who participated in a 6-month , r and omized trial comparing lanthanum carbonate with calcium carbonate were eligible for a 24-week , open-label extension . Lanthanum carbonate-treated patients continued taking their established maintenance dose ( ‘ continued-lanthanum group ’ ) and calcium carbonate-treated patients switched to lanthanum carbonate , 375–3,000 mg/day ( ‘ switch group ’ ) . Patients could also enter a further 2-year extension . Efficacy parameters , including serum phosphate , were monitored . Results : Mean serum phosphate was ∼1.80 mmol/l throughout the trial . The percentage of patients with controlled serum phosphate ( ≤1.80 mmol/l ) after the 6-month extension was 63.3 and 58.4 % in the continued-lanthanum and switch groups , respectively ; after the 2-year extension , 54.4 % of patients had controlled serum phosphate . After discontinuation of calcium carbonate and initiation of lanthanum carbonate , the hypercalcemia incidence was 2.7 % , compared with 20.2 % during the double-blind phase . Calcium × phosphate product was maintained at an acceptable level . Lanthanum carbonate was well tolerated ; adverse events were mild/moderate and mainly gastrointestinal . Conclusions : Lanthanum carbonate maintains effectiveness with continued tolerability for up to 3 years Background Serum phosphorus control is critical for chronic kidney disease ( CKD ) 5D patients . Currently , clinical profile for an oral phosphorus binder in the mainl and Chinese population is not available . Objective To establish the efficacy , safety , and tolerability of lanthanum carbonate in CKD 5D patients . Design Multicenter , r and omized , double blind , placebo-controlled study . A central r and omization center used computer generated tables to allocate treatments . Setting Twelve tertiary teaching hospitals and medical university affiliated hospitals in mainl and China . Participants Overall , 258 hemodialysis or continuous ambulatory peritoneal dialysis ( CAPD ) adult patients were enrolled . InterventionAfter a 0–3-week washout period and a 4-week lanthanum carbonate dose-titration period , 230 patients were r and omized 1:1 to receive lanthanum carbonate ( 1500 mg-3000 mg ) or placebo for a further 4-week maintenance phase . Main outcome measures Efficacy and safety of lanthanum carbonate to achieve and maintain target serum phosphorus concentrations were assessed . Results In the titration phase , serum phosphorus concentrations of all patients decreased significantly . About three-fifths achieved target levels without significantly disturbing serum calcium levels . At the end of the maintenance period , the mean difference in serum phosphorus was significantly different between the lanthanum carbonate and placebo-treated groups ( 0.63±0.62 mmol/L vs. 0.15±0.52 mmol/L , P < 0.001 ) . The drug-related adverse effects were mild and mostly gastrointestinal in nature . Conclusion Lanthanum carbonate is an efficacious and well-tolerated oral phosphate binder with a mild AE profile in hemodialysis and CAPD patients . This agent may provide an alternative for the treatment of hyperphosphatemia in CKD 5D patients in mainl and China . Trial registration No. BACKGROUND The majority of patients with end-stage renal disease on dialysis are hyperphosphataemic . Lanthanum carbonate has been shown to be a highly effective phosphate binder in pre- clinical studies . A 4-week , open-label , dose-titration trial was conducted to assess the ability of lanthanum carbonate to control phosphate levels in patients with chronic renal failure . METHODS This preliminary study was of 6 weeks duration : 2 weeks of washout followed by 4 weeks of dose titration . Patients ( n = 59 ) were titrated on the basis of weekly serum phosphate levels from a daily dose of 375 mg lanthanum carbonate to a maximum dose of 2250 mg . Patients were maintained on the dose that controlled serum phosphate to between 1.30 and 1.80 mmol/l ( 4.03 - 5.58 mg/dl ) . Serum phosphate levels represented the main efficacy assessment . Safety was also evaluated . RESULTS Most patients were successfully titrated to 1500 and 2250 mg lanthanum/day ( mean dose at end of titration : 1278 mg ) . At completion of the study 70 % of patients achieved a serum phosphate of < or=1.80 mmol/l . The use of lanthanum carbonate in patients undergoing continuous ambulatory peritoneal dialysis or haemodialysis was generally well tolerated . CONCLUSIONS Lanthanum carbonate , a new non-aluminium , non-calcium phosphate binder , effectively reduces serum phosphate levels . Results of longer-term efficacy and safety studies are awaited with interest BACKGROUND Atherosclerosis and vascular calcification ( VC ) progression in chronic kidney disease is favored by disturbances of mineral metabolism . We compared the effect of phosphate binder lanthanum ( La ) carbonate with sevelamer-HCl on atherosclerosis , VC and bone structure and function in mice with chronic renal failure ( CRF ) . METHODS Apolipoprotein E-deficient ( apoE(-/- ) ) mice were r and omized to one non-CRF and three CRF groups , fed with st and ard diet ( one non-CRF and one CRF ) or diet supplemented with either 3 % lanthanum carbonate ( La3 % ) or 3 % sevelamer-HCl ( Sev3 % ) . RESULTS Both La3 % and Sev3 % supplemented CRF mice displayed a decrease of serum phosphorus , calcification at both intimal and medial aortic sites and atherosclerosis . This was associated with a reduction of plaque Type I collagen expression by both binders and of positive nitrotyrosine staining in response to sevelamer-HCl only . Increased mineral apposition and bone formation rates in unsupplemented CRF mice were reduced by Sev3 % but not by La3 % . CONCLUS 
    Output:
    
The limited number of trials was insufficient to show the superiority of LC over other treatments in lowering vascular calcification or cardiovascular events and in improving bone morphology , bone metabolism , or bone turn-over parameters  .
LC  decreased the serum phosphorus level and calcium × phosphate product ( Ca × P ) as compared to placebo .
LC , calcium carbonate ( CC ) , and sevelamer hydrochloride ( SH ) were comparable in terms of controlling the serum phosphorus , Ca × P product , and intact parathyroid hormone ( iPTH ) levels .
However , LC result ed in a lower serum calcium level and a higher bone-specific alkaline phosphatase level compared with CC .
LC had higher total cholesterol and low-density lipoprotein ( LDL ) cholesterol levels compared with SH .
LC-treated patients appeared to have a higher rate of vomiting and lower risk of hypercalcemia , diarrhea , intradialytic hypotension , cramps or myalgia , and abdominal pain .
Meta- analysis showed no significant difference in the incidence of other side effects .
Accumulation of LC in blood and bone was below toxic levels .
Conclusions LC has high efficacy in lowering serum phosphorus and iPTH levels without increasing the serum calcium .
Current evidence does not show a higher rate of adverse effects for LC compared with other treatments , except for a higher incidence of vomiting .
Moreover , LC accumulation in blood and bone was below toxic levels .