6/28/23, 10:56 PM LANDMARK Pathway Feedback Search Clinical Topics Home Studies LANDMARK LANDMARK Disease Chronic kidney disease Trial question Is lanthanum carbonate superior to calcium carbonate in patients with CKD and hyperphosphatemia undergoing hemodialysis? Study design Multi-center Open label RCT Population Characteristics of study participants 40.0% female N = 2135 60.0% male 2135 patients (864 female, 1271 male) Inclusion criteria: patients with CKD and hyperphosphatemia undergoing hemodialysis Key exclusion criteria: patients undergoing peritoneal dialysis; patients with contraindications to lanthanum carbonate or calcium carbonate; pregnancy Interventions N=1063 lanthanum carbonate (total daily dose of 750-2250 mg PO) N=1072 calcium carbonate (total daily dose of 3,000 mg PO) Primary outcome Cardiovascular events https://web.pathway.md/studies/recXcGyxCxDinfbza 1/2 6/28/23, 10:56 PM LANDMARK Pathway 13.8 % 13.8 12.5 10.4 % 6.9 % 3.5 % No significant difference 0.0 % Lanthanum carbonate Calcium carbonate No significant difference in cardiovascular events (13.8% vs. 12.5%; HR 1.11, 95% CI 0.88 to 1.41) Secondary outcomes No significant difference in death from any cause (15% vs. 13.8%; HR 1.1, 95% CI 0.88 to 1.37) Significant increase in death from cardiovascular causes (5.5% vs. 3.6%; HR 1.51, 95% CI 1.01 to 2.27) Significant increase in the percentage of patients with secondary hyperparathyroidism (9.9% vs. 6.3%; HR 1.62, 95% CI 1.19 to 2.2) Safety outcomes No significant difference in adverse events. Conclusion In patients with CKD and hyperphosphatemia undergoing hemodialysis, lanthanum carbonate was not superior to calcium carbonate with respect to cardiovascular events. Reference Hiroaki Ogata, Masafumi Fukagawa, Hideki Hirakata et al. Effect of Treating Hyperphosphatemia With Lanthanum Carbonate vs Calcium Carbonate on Cardiovascular Events in Patients With Chronic Kidney Disease Undergoing Hemodialysis: The LANDMARK Randomized Clinical Trial. JAMA. 2021 May 18;325(19):1946-1954. Open reference URL https://web.pathway.md/studies/recXcGyxCxDinfbza 2/2