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Kidney Week

Abstract: TH-PO1043

Four Times Daily versus Three Times Daily Dosing of Phosphorus Binders Does Not Improve Serum Phosphorus in Dialysis Patients

Session Information

Category: Mineral Disease

  • 1201 Mineral Disease: Ca/Mg/PO4


  • Muther, Richard S., Kidney Associates of Kansas City, Kansas City, Missouri, United States

Hyperphosphatemia associates with poor outcomes in ESRD patients. Dietary phosphorus restriction and phosphorus binding compounds taken with meals are the primary (though often ineffective) treatments to limit intestinal phosphorus absorption and lower serum phosphorus. Because phosphorus is known to undergo enterohepatic recirculation, a quality improvement project was conducted to determine whether bedtime administration of phosphate binder could favorably impact serum phosphorus.


Twenty-nine (29) dialysis patients with hyperphosphatemia received their daily phosphorus binding dose either 3 times a day with meals or 4 times a day with meals and at bedtime for 3 months, crossing over to the alternate dosing schedule for an additional 3 months. The type and total daily dose of binder was not changed and patients continued their usual phosphorus restricted diet.


Standard of care data over the project period was available on 23 patients (3 expired, 2 withdrew, 1 transfer). Serum phosphorus did not change over the 3 month course of treatment, regardless of a 3 times daily with meals (5.63 ± 1.4 to 5.72 ± 1.49) or 4 times daily with meals and at bedtime (5.71 ± 1.01 to 5.95 ± 1.47) dosing schedule. The results were not influenced by baseline serum phosphorus (greater or less than 6.0 mg/dL) or the type of phosphorus binder.


If enterohepatic recirculation of dietary phosphorus affects serum phosphorus in dialysis patients, it does not appear to respond to increasing the frequency of administration of phosphorus binding compounds.