***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: BACKGROUND AND OBJECTIVES Lanthanum carbonate ( LC ) is a nonaluminum , noncalcium phosphate binder that is effective for hyperphosphatemia in dialysis patients . However , its efficacy and cost-effectiveness as second-line therapy have not been fully examined . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS We first conducted a multicenter , open-label , 16-week clinical trial to examine the effect of additive LC in 116 hemodialysis patients who had uncontrolled hyperphosphatemia with conventional phosphorus-lowering therapy alone .  Based on these clinical data , a state transition model was developed to evaluate the benefits and costs associated with LC as second-line therapy . Reduced risks for cardiovascular morbidity and mortality among patients treated with LC arise through more of the population achieving the target phosphorus levels . Uncertainty was explored through sensitivity analysis . RESULTS After 16 weeks of additive LC  treatment , mean serum phosphorus levels decreased from 7.30 ± 0.90 to 5.71 ± 1.32 mg/dl , without significant changes in serum calcium or intact parathyroid hormone levels . A subsequent cost-effectiveness analysis showed that compared with conventional treatment , additive LC incurred an average additional lifetime cost of $ 22,054 per person and conferred an additional 0.632 quality -adjusted life years ( QALYs ) . This result ed in an incremental cost-effectiveness ratio of $ 34,896 per QALY gained . Applying a cost-effectiveness threshold of $ 50,000 per QALY , a probabilistic sensitivity analysis showed that additive LC had a 97.4 % probability of being cost-effective compared with conventional treatment . CONCLUSIONS Our results indicate that the use of LC as second-line therapy would be cost-effective among hemodialysis patients with uncontrolled hyperphosphatemia in Japan Vascular calcification ( VC ) contributes to cardiovascular disease in hemodialysis ( HD ) patients , especially with diabetes mellitus ( DM ) complications . No r and omized studies have been published regarding the effect of lanthanum carbonate ( LC ) on VC progression in DM patients . The aim of this study was to evaluate the effects of lanthanum carbonate on the progression of VC in HD patients with type 2 DM . We conducted a r and omized controlled trial comparing LC with calcium carbonate ( CC ) in 43 HD patients at a single dialysis center . Estimations of aortic calcification index ( ACI ) by abdominal computed tomography were performed twice for each patient ( at baseline and 12 months ) . Forty-one patients completed the study ( 19 LC , 22 CC ) . When ACI at baseline was ≦0.48 ( median of baseline ACI ) , median change in ACI ( Δ%ACI ) was 20.44 ( 11.50 - 36.80 % ) in the LC group , and 40.00 ( 33.30 - 92.60 % ) in the CC group ( P = 0.026 ) . On the other h and , when ACI at baseline was > 0.48 , the median change in ACI ( Δ%ACI ) was 6.42 ( 3.13 - 24.40 % ) in the LC group , and 8.08 ( 5.68 - 12.20 % ) in the CC group ( P = 1.000 ) . Serum markers of chronic kidney disease-mineral and bone disorder ( CKD-MBD ) , HbA1c , dose of vitamin D analogues , and side-effects of medications did not change in either group throughout the study except int-PTH increased in the LC group . This study indicated that administration of LC inhibited the progression of VC in patients receiving HD for type 2 DM , only in cases of slight VC compared with CC BACKGROUND Lanthanum carbonate ( LC ) is a non-calcium-containing phosphate binder and shows a comparable effect with other phosphate binders on hyperphosphatemia in dialysis patients .  LC also contributes to a reduced oral calcium load compared with calcium carbonate ( CaC ) treatment . However , no crossover studies which compare the influence on serum calcium level between treatments with LC and CaC in hemodialysis ( HD ) patients have been carried out . METHODS After washout for 2 weeks , 50 patients on HD were r and omized ( 1 : 1 ) to receive LC or CaC for 3 months . Thereafter , patients underwent a second 2-week washout period and were switched to the alternative binder for the next 3 months . Mineral and bone metabolism markers were measured with the changes of vitamin D doses . RESULTS The serum phosphate level showed a similar decrease from baseline to 3 months in both groups . During the study periods , hypercalcemia was observed only in patients taking CaC. The dose of vitamin D analogue was increased more frequently in the patients of the LC group compared with LC group . The iPTH level showed a significant decrease in the CaC group , but not in the LC group . Serum levels of BAP , TRAP5b , and ALP were significantly elevated in the LC group , whereas the FGF-23 level showed a significant decrease . CONCLUSION LC effectively reduced the serum phosphate level ( like CaC ) and allowed the vitamin D analogue dosage to be increased without hypercalcemia in HD patients .  LC is one of the useful phosphate binders without hypercalcemia . ( UMIN-CTR registration number : UMIN000002331 ) Treating hyperphosphatemia without increasing the calcium load in chronic kidney disease patients on dialysis is important , as conventional treatment frequently results in ectopic calcification . Sevelamer , a monotherapy for hyperphosphatemia is frequently associated with gastrointestinal disorders , often result ing in discontinuation of treatment . Lanthanum carbonate is a novel non-calcium-based phosphate binder for the treatment of chronic kidney disease . Here , its clinical efficacy and safety were assessed in Japanese dialysis patients . A placebo-controlled , r and omized , double-blind , parallel group , multicenter study was performed in Japanese dialysis patients . Patients were treated with various dosages of lanthanum carbonate or a placebo daily for six weeks . The primary efficacy endpoint was the change in serum phosphate level from the baseline . Secondary endpoints included achievement rates to target serum phosphate levels and changes in serum calcium levels . Safety was evaluated by the incidence of drug-related and treatment-emergent adverse events . A significant reduction in serum phosphate level was demonstrated for all dosages from Week 1 . This dose-dependent effect was also observed in the changes in serum calcium x phosphate product , yet there was no notable difference in serum calcium or serum intact parathyroid hormone levels . The incidence of drug-related adverse events was dose-dependent , with the most common being gastrointestinal symptoms .  Lanthanum carbonate effectively controls serum phosphate levels and is generally tolerable to Japanese chronic kidney disease patients on dialysis , as reported for the Caucasian population . The optimal dosage in Japanese patients needs to be confirmed using a flexible-dose titration schedule BACKGROUND Lanthanum carbonate ( LC ) has been proposed as a new phosphate binder . Presented here are the results from one centre that participated in a multicentre trial to assess the effect of treatment with LC and calcium carbonate ( CC ) on the evolution of renal osteodystrophy in dialysis patients . Bone biopsies were performed at baseline , after 1 year of treatment and after a further 2-year follow-up period to assess the lanthanum concentration in bone and plasma . METHODS Twenty new dialysis patients were r and omized to receive LC  ( median dose 1250 mg ) for 1 year ( n = 10 ) , followed by 2 years of CC treatment or CC ( n = 10 ) during the whole study period ( 3 years ) . RESULTS After 36 weeks of treatment , steady state was reached with plasma lanthanum levels varying around 0.6 ng/ml . Six weeks after cessation of 1 year of treatment , the plasma lanthanum levels declined to a value of 0.17 + /- 0.12 ng/ml ( P < 0.05 ) and after 2 years to 0.09 + /- 0.03 ng/ml . Plasma and bone lanthanum levels did not correlate with the average lanthanum dose at any time point . The mean bone concentration in patients receiving LC increased from 0.05 + /- 0.03 to 2.3 + /- 1.6 microg/g ( P < 0.05 ) after 1 year and slightly decreased at the end of the study to 1.9 + /- 1.6 microg/g ( P < 0.05 ) . CONCLUSIONS Bone deposition after 1 year of treatment with LC is low ( highest concentration : 5.5 microg/g ) . There is a slow release of lanthanum from its bone deposits 2 years after the discontinuation of the treatment and no association with aluminium-like bone toxicity BACKGROUND Renal osteodystrophy is a common complication of end-stage renal disease ( ESRD ) and is a major cause of morbidity in patients with ESRD . High serum levels of phosphorus , calcium and parathyroid hormone are associated with the development of this disease . The effects on bone of treatment with lanthanum carbonate , a new phosphate binder , and calcium carbonate were assessed in patients with ESRD . METHODS This was an open-label , multicenter , parallel-group study . Patients were recruited within 12 weeks of commencing dialysis . Following screening , phosphate binder administration was stopped , tetracycline labeling administered and a transiliac bone biopsy taken . After r and omization to lanthanum carbonate or calcium carbonate , patients were titrated to an optimum dose for 8 weeks and maintained at this dose for 44 weeks . The bone was then labeled and a second biopsy taken . Biopsy sample s were analyzed histomorphometrically . RESULTS Paired bone biopsies from 33 lanthanum carbonate- and 30 calcium carbonate-treated patients were suitable for analysis . None of the patients on either treatment developed osteomalacia . Assessment of activation frequency changes showed that 41 % of biopsies from lanthanum carbonate-treated patients moved towards normal ( observed values at the follow-up biopsy were closer to expected values than were the baseline values , so patients were considered to be improved ) compared with 23 % of calcium carbonate-treated patients ( p = 0.15 ) . CONCLUSIONS This study indicates that there was no evidence of aluminum-like toxicity with lanthanum carbonate after 1 year of treatment in ESRD patients commencing dialysis , and there appeared to be a beneficial effect on bone-cell function and activity compared with calcium carbonate BACKGROUND Abnormalities in serum calcium , phosphorus , and parathyroid hormone ( PTH ) concentrations are common in patients with chronic kidney disease and have been associated with increased morbidity and mortality . No clinical trials have been conducted to clearly identify categories of calcium , phosphorus , and PTH levels associated with the lowest mortality risk . Current clinical practice guidelines are based largely on expert opinions , and clinical ly relevant differences exist among guidelines across countries . We sought to describe international trends in calcium , phosphorus , and PTH levels during 10 years and identify mortality risk categories in the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) , an international study of hemodialysis practice s and associated outcomes . STUDY DESIGN Prospect i ve cohort study . PARTICIPANTS 25,588 patients with end-stage renal disease on hemodialysis therapy for longer than 180 days at 925 facilities in DOPPS I ( 1996 - 2001 ) , DOPPS II ( 2002 - 2004 ) , or DOPPS III ( 2005 - 2007 ) . PREDICTORS Serum calcium , albumin-corrected calcium ( Ca(Alb ) ) , phosphorus , and PTH levels . OUTCOMES Adjusted hazard ratios for all-cause and cardiovascular mortality calculated using Cox models . RESULTS Distributions of mineral metabolism markers differed across DOPPS countries and phases , with lower calcium and phosphorus levels observed in the most recent phase of DOPPS . Survival models identified categories with the lowest mortality risk for calcium ( 8.6 to 10.0 mg/dL ) , Ca(Alb ) ( 7.6 to 9.5 mg/dL ) , phosphorus ( 3.6 to 5.0 mg/dL ) , and PTH ( 101 to 300 pg/mL ) . The greatest risk of mortality was found for calcium or Ca(Alb ) levels greater than 10.0 mg/dL , phosphorus levels greater than 7.0 mg/dL , and PTH levels greater than 600 pg/mL and in patients with combinations of high-risk categories of calcium , phosphorus , and PTH . LIMITATIONS Because of the observational nature of DOPPS , this study can only indicate an association between mineral metabolism categories and mortality . CONCLUSIONS Our results provide important information about mineral metabolism trends in hemodialysis patients in 12 countries during a decade . The risk categories identified in the DOPPS cohort may be relevant to efforts at international harmonization of existing clinical guidelines for mineral metabolism BACKGROUND The efficacy of lanth 
    Output:
    
Lanthanum carbonate appeared to be associated with a significant reduction in progression of vascular calcification and a beneficial effect on bone outcomes without aluminum-like toxicity .
Lanthanum carbonate was associated with significantly lower serum calcium , similar serum Ca × P product and higher serum iPTH compared with calcium salts in patients with chronic kidney disease .
Conclusion Lanthanum carbonate could delay the progression of vascular calcification and benefit chronic kidney disease patients on bone outcomes .
Lanthanum carbonate could achieve similar proportion of phosphate-controlled patients as calcium-based phosphate binders with lower incidence of hypercalcemia