Lanthanum Carbonate vs Sevelamer: Lower MACE Risk in Dialysis

Among patients receiving dialysis with hyperphosphatemia, initiating lanthanum carbonate was associated with lower risks of major adverse cardiovascular events (MACE) and death than initiating sevelamer, according to a target trial emulation published in the Journal of the American Society of Nephrology.

The investigators noted that hyperphosphatemia, a key component of chronic kidney disease–mineral and bone disorder, is associated with cardiovascular morbidity and mortality in patients receiving dialysis. Although non–calcium-based phosphate binders such as sevelamer and lanthanum carbonate are widely used, evidence comparing their effects on clinical outcomes is limited, they wrote.

Using data from the China Renal Data System, the researchers applied an active-comparator, new-user design to patients with no documented prior MACE who initiated either drug, matching them 1:1 by propensity score. The primary outcome was MACE, a composite of myocardial infarction, stroke, or cardiovascular death. Secondary outcomes included all-cause and cardiovascular mortality.

Among 10,518 matched patients (5,259 per group), 280 MACE events occurred in the lanthanum carbonate group and 325 in the sevelamer group over 3 years, for a cumulative incidence of 9.5% vs 12.2%. Lanthanum carbonate was associated with a lower risk of MACE (hazard ratio [HR], 0.79; 95% CI, 0.68-0.92), corresponding to an absolute risk reduction of 2.68% and a number needed to treat of 37. It was also associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.75-0.93) and cardiovascular mortality (HR, 0.72; 95% CI, 0.59-0.88).

Results were consistent across sensitivity and subgroup analyses, and the association with lower MACE risk remained significant in competing-risk analyses, the authors reported. They concluded that lanthanum carbonate initiation was associated with lower risks of cardiovascular events and mortality than sevelamer in this population.

Source: Liu J, Jin L, Luo F, et al. Comparative cardiovascular outcomes of lanthanum carbonate and sevelamer in dialysis. J Am Soc Nephrol. Published online October 6, 2026. doi:10.1681/ASN.0000001289