Objective To observe the therapeutic effect of lanthanum hydroxide (LH) on hyperphosphatemia in rats with chronic renal failure and explore its mechanism. Methods Thirty Wistar rats were randomly divided into five groups, with 6 rats in each group. No hyperphosphatemia model of chronic renal failure was prepared in the control group, and the hyperphosphatemia models were prepared in the model group, low-dose group, medium-dose group and high-dose group. After modeling, the rats in the low-dose group, medium-dose group, and high-dose group were given 0. 1, 0. 2, and 0. 4 g/kg LH by gavage, respectively, for a total of 8 weeks. The rats in the model group and control group were not treated. Calcium (Ca), phosphorus (PI), creatinine (Scr) and urea nitrogen (BUN) kits were used to detect serum Ca, PI, Scr and BUN, and hematoxylin-eosin (HE) and Masson's staining were used to detect the pathological changes of kidney tissues. In addition, liquid chromatography-mass spectrometry (LC-MS) was used to detect renal differential metabolites in the control group, model group, low-dose, medium-does and high-dose groups, and we analyzed the GO function and KEGG enrichment of renal differential metabolites. Results After 8 weeks of administration, compared with the model group, the serum PI, Scr and BUN levels of rats with chronic renal failure and hyperphosphatemia decreased in the LH groups after treatment, and renal injury, cystic dilatation of renal tubules and inflammatory cell infiltration were improved, and cystic dilatation of renal tubules, inflammatory cell infiltration and fibrosis degree, and renal injury were alle‑ viated. They were in a dose-dependent manner (all P<0. 05) . The differential metabolites of renal function with compensatory up-regulation were D-alanyl-D-alanine, 6-tert-butylsulfonic acid, aminodicyclodicarboxylic acid and 1D inositol. The differential metabolites of renal function with compensatory down-regulation were DL-citrulline, 2, 3-prostaglandin, ornithine, 2-sulfoxymethyl, and p-carboxybenzene sulfonamide, etc. The metabolic pathways enriched by these metabolites in renal function differences included urea cycle, arginine and proline metabolism, pentose phosphate pathway, lysine degradation, malate-aspartic acid cycle, aspartic acid metabolism, and alanine metabolism, etc. Conclusions LH has a therapeutic effect on hyperphosphatemia of chronic renal failure rats, and high-dose LH is the most significant. LH may play a therapeutic role through urea cycle and arginine metabolism. [ABSTRACT FROM AUTHOR]