***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Lanthanum carbonate ( LC ) , an effective non-calcium phosphate binder is widely used to manage hyperphosphatemia in patients with chronic kidney disease ( CKD ) on dialysis . Recently , the additional indication for control of hyperphosphatemia in CKD patients not on dialysis has been approved . METHODS A multicenter , r and omized , double-blind , placebo-controlled trial to confirm the efficacy and safety of LC in Japanese hyperphosphatemic stage 4 - 5 CKD patients not on dialysis . After a 4-week run-in period , 143 eligible subjects with serum phosphate levels of 5.6 - 11.0 mg/dL were r and omized ( 2 : 1 ) to receive LC or placebo ( 88 vs. 55 ) for 8 weeks ; 119 subjects completed the study ( 76 vs. 43 ) . The starting LC dose was 750 mg/day , which was then up-titrated to 2,250 mg/day as needed while tolerated . Primary efficacy analysis was performed on the intent-to-treat ( ITT ) population of 141 patients ( 86 vs. 55 ) . RESULTS LC produced a significantly greater reduction in serum phosphate level compared with placebo after 8 weeks of treatment ( difference , 0.97 ( 95 % CI : 0.58 , 1.37 ) mg/ dL ; p < 0.0001 ) . The cumulative proportion of subjects with controlled phosphate levels ≤ 4.6 mg/dL was higher in the LC group than the placebo group ( 59.56 % vs. 10.46 % ) . LC caused significantly greater reductions in serum Ca × P product and urinary phosphate excretion compared with placebo  . The safety profile  of LC was similar to that of placebo . CONCLUSIONS This study demonstrated the effectiveness of LC to control hyperphosphatemia in pre-dialysis CKD patients BACKGROUND JTT-751 is a novel phosphate binder containing ferric citrate as the active ingredient . METHODS In this Phase 3 , multicenter , r and omized , open-label , parallel-group study , we compared the efficacy and safety of JTT-751 and sevelamer hydrochloride in patients undergoing hemodialysis . A total of 230 patients with a serum phosphate ≥1.97 and < 3.23 mmol/L were r and omized to JTT-751 ( dose adjusted between 1.5 and 6.0 g/day ) or sevelamer hydrochloride ( dose adjusted between 3.0 and 9.0 g/day ) for 12 weeks . The primary outcome was change in serum phosphate from baseline to end of treatment . Secondary outcomes included the changes in corrected serum calcium and intact parathyroid hormone ( PTH ) . The changes in ferritin , transferrin saturation and erythropoiesis-stimulating agent dose were additional outcomes . RESULTS Changes in serum phosphate at the end of treatment were -0.82 mmol/L in the JTT-751 group and -0.78 mmol/L in the sevelamer group , establishing non-inferiority of JTT-751 compared with sevelamer ( least squares mean , -0.03 mmol/L ; 95 % confidence interval , -0.13 to 0.07 mmol/L ) . Corrected serum calcium increased and PTH decreased from baseline within both groups ; changes between groups were similar . Gastrointestinal disorders were the most common adverse events in both groups ; the incidence of diarrhea was higher in the JTT-751 group , while constipation occurred frequently in the sevelamer group . Treatment with JTT-751 result ed in significant relative increases in serum ferritin and transferrin saturation . CONCLUSIONS Efficacy and safety of JTT-751 was comparable to sevelamer in patients on hemodialysis with hyperphosphatemia . Differential adverse effects were observed ; biochemical markers of iron status increased in patients treated with JTT-751 . TRIAL REGISTRATION NUMBER CTI-111433 ( The Japan Pharmaceutical Information Center at : http//www . clinical trials.jp ) . Date of registration : 7 March 2011 Background Secondary hyperparathyroidism ( SHPTH ) is present in many patients with end-stage renal disease ( ESRD ) and has been linked to uremic bone disease . Parathyroid hormone ( PTH ) levels are affected by calcium , vitamin D , and phosphorus . Recent data suggests that serum magnesium may also modulate PTH levels . Objective The aim of this retrospective study was to investigate the impact of different calcium ( Ca ) and magnesium ( Mg ) concentrations of dialysis solutions on serum Mg and serum PTH levels in peritoneal dialysis ( PD ) patients . Patients and methods Two groups of PD patients -group A ( n = 17 ) on “ st and ard ” Ca and Mg dialysis solution ( SCa – MgD )  ( Ca : 1.62 mmol/l , Mg : 0.75 mmol/l and Lactate 35 mmol/l ) , and group B ( n = 29 ) on “ low ” Ca and Mg dialysis solution ( LCa – MgD ) ( Ca : 1.25 mmol/l , Mg : 0.25 mmol/l and Lactate 40 mmol/l ) , on PD for more than 6 months , were studied . Calcium carbonate ( CaCO3 ) was used as the phosphate ( P ) binder in 87 % ( 40/46 ) of the patients . Biochemical parameters were evaluated every 1–2 months over 6 months and the mean values were computed . Results No significant differences were found between the two groups in all parameters except for serum Mg and PTH . Serum Mg was higher in SCa – MgD group compared to those in the LCa – MgD group ( 1.05 ± 0.19 vs 0.90 ± 0.23 mmol/l , respectively ) and serum PTH was higher in LCa – MgD group compared to those in SCa – MgD group ( 72.3 ± 64.2 vs 31.1 ± 39.0 pmol/l , respectively ) even though serum Ca was not different . There was a statistically significant inverse correlation between serum Mg and PTH levels ( r = −0.357 , p < 0.05 ) . ConclusionS erum Mg is lower and serum PTH higher in patients dialyzed with lower Mg concentration dialysis solution compared to those with higher Mg concentration dialysis solution . Our study confirms previous reports that serum Mg may have a suppressive role on PTH synthesis and /or secretion , and thus may play a role in pathogenesis of adynamic bone disease that often develops in patients on chronic PD with high calcium and high magnesium concentrations Background and Aims : Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients . This is a prospect i ve study that compares the effects of calcium acetate and sevelamer on coronary calcification ( CAC ) and bone histology . Methods : 101 hemodialysis patients were r and omized for each phosphate binder and su bmi tted to multislice coronary tomographies and bone biopsies at entry and 12 months . Results : The 71 patients who concluded the study had similar baseline characteristics . On follow-up , the sevelamer group had higher levels of intact parathyroid hormone ( 498 ± 352 vs. 326 ± 236 pg/ml , p = 0.017 ) , bone alkaline phosphatase ( 38 ± 24 vs. 28 ± 15 U/l , p = 0.03 ) and deoxypyridinoline ( 135 ± 107 vs. 89 ± 71 nmol/l , p = 0.03 ) and lower LDL cholesterol ( 74 ± 21 vs. 91 ± 28 mg/dl , p = 0.015 ) . Phosphorus ( 5.8 ± 1.0 vs. 6 ± 1.0 mg/dl , p = 0.47 ) and calcium ( 1.27 ± 0.07 vs. 1.23 ± 0.08 mmol/l , p = 0.68 ) levels did not differ between groups . CAC progression ( 35 vs. 24 % , p = 0.94 ) and bone histological diagnosis at baseline and 12 months were similar in both groups . Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption ( eroded surface , ES/BS = 9.0 ± 5.9 vs. 13.1 ± 9.5 % , p = 0.05 ) , whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate ( BFR/BS = 0.015 ± 0.016 vs. 0.062 ± 0.078 , p = 0.003 for calcium and 0.017 ± 0.016 vs. 0.071 ± 0.084 μm3/μm2/day , p = 0.010 for sevelamer ) . Conclusions : There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups Background Parathyroid hormone ( PTH ) is a cardinal factor in the pathogenesis of bone disease in the dialysis population . The spectrum of renal osteodystrophy has been reported to have changed during the past years , and adynamic bone disease has emerged as the most common bone disorder in these patients . Continuous ambulatory peritoneal dialysis ( CAPD ) is considered a risk factor for the development of this condition , and furthermore , the adynamic bone lesion is associated with a state of relative hypoparathyroidism ( hypo-PTH ) . Calcium , vitamin D , and phosphorus play a key role in the control of parathyroid gl and function in uremic patients . However , magnesium may also be able to modulate PTH secretion in a way similar to calcium . Objective The aims of this study were ( 1 ) to analyze the serum Mg concentration in a large group of CAPD patients , ( 2 ) to study the relationship between serum Mg and PTH levels , and ( 3 ) to investigate whether this relationship is independent of other factors , such as calcium , phosphorus , and calcitriol , that regulate parathyroid function . Patients and Methods We studied 51 stable patients , aged 23 – 77 years , under maintenance CAPD for more than 6 months ( range 8 – 48 months ) .  Calcium carbonate was used as a phosphate binder in all patients , and 9 subjects also received aluminum hydroxide . No patient had been previously treated with vitamin D. Biochemical parameters were prospect ively evaluated over 6 months , and the mean values were computed . Results The mean serum Mg was 1.08 ± 0.19 mmol/L , and hypermagnesemia , defined as a Mg level higher than 1.01 mmol/L , was found in 30 patients ( 59 % ) . Thirty-one subjects ( 60 % ) had an intact PTH ( iPTH ) level lower than 120 pg/mL and were diagnosed as having relative hypo-PTH . Except for the values of iPTH and alkaline phosphatase , the only difference between the two groups was the serum Mg concentration , which was significantly higher in patients with hypo-PTH ( 1.16 ± 0.15 mmol/L vs 0.91 ± 0.14 mmol/L ; p < 0.001 ) . Furthermore , iPTH levels were lower in patients with hypermagnesemia than in subjects with normal serum Mg ( 69 ± 49 pg/mL vs 190 ± 89 pg/mL , p < 0.001 ) . There was a significant correlation between serum Mg and PTH levels ( r = –0.70 , p < 0.01 ) . After controlling for the effect of other variables by partial correlation analysis , a significant positive association between P and PTH ( r = 0.25 , p < 0.05 ) , and a negative relationship between Mg and PTH ( r = –0.57 , p < 0.001 ) were evident . A forward stepwise multiple regression analysis showed that only P and Mg predicted PTH values ( multiple r = 0.59 , p < 0.001 ) . Conclusions Hypermagnesemia and hypoparathyroidism are frequent in CAPD patients . There is a significant inverse relationship between serum Mg concentration and iPTH levels . Furthermore , this association is independent of the most important factors regulating parathyroid gl and function ( calcium , phosphorus , and calcitriol ) . These results suggest that hypermagnesemia may have a suppressive effect on PTH synthesis and /or secretion . Therefore , elevated serum Mg levels may play a role in the pathogenesis of adynamic bone disease Background High levels of circulating fibroblast growth factor 23 ( FGF23 ) are associated with chronic kidney disease ( CKD ) progression and high mortality . In the Phosphate Reduction Evaluation of FGF23 in Early CKD Treatment ( PREFECT ) study , we assessed the effect of reducing intestinal phosphate absorption using lanthanum carbonate on FGF23 levels in norm 
    Output:
    
Sevelamer , lanthanum , calcium , iron , diet and combinations of active treatments ( calcium or sevelamer or lanthanum and combination of calcium and sevelamer ) result ed in significantly lower serum phosphate as compared to placebo ( moderate to very low quality of evidence ) .
We found no statistically significant differences between active treatment categories in lowering serum phosphate .
Sevelamer , lanthanum and diet result ed in lower serum calcium compared to calcium ( moderate quality evidence for lanthanum and diet ; low quality evidence for Sevelamer ) .
Iron , sevelamer and calcium yielded lower parathyroid hormone levels as compared to lanthanum .
Meta-regression analyses did not yield a statistically significant association between treatment effect and trial duration .
DISCUSSION / CONCLUSIONS We found few differences between treatments in impact on phosphate and differences in parathyroid hormone .
Relative to calcium , sevelamer , lanthanum and diet showed significant reduction in serum calcium from baseline .