Abstract: FR-PO802

Bringing Down the Phosphorus: A Novel Approach to Improve the Quality of Hemodialysis Phosphate Management

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Brauer, Alexander, UWSMPH, Madison, Wisconsin, United States
  • Maursetter, Laura J., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

High phosphate levels are associated with vascular calcifications, osteodystrophy and an increased risk of cardiac mortality. According to major investigations such as the Dialysis Outcomes and Practice Patterns Studies, approximately 50% of dialysis patients have hyperphosphatemia. Hyperphosphatemia is both a common and serious complication for patients receiving dialysis therapy. Despite this fact, clinical management of hyperphosphatemia remains subpar. This is thought to be largely due to patient compliance with binders, cost of therapy and dietary constraints.


In this single center quality improvement project looking at the prevalence of phosphorus control and the willingness of patients to make a change. The serum phosphate levels from the previous 6 months were evaluated. Patients were classified into 3 groups: good control (phosphorus <6), fluctuating control (phosphorus with 2-3 values >6) or poor control (phosphorus >6 for more than 4 values). Anyone in the fluctuating or poor control group was scheduled into 4 weekly meetings for the purpose of using behavioral change theory, an intervention that has been shown effective in dialysis patients. Management modifications were developed by the patients based on the perceived needs. These included changes that have been proven effective such as specific dietary consultation, economic concerns, and meal planning/preparation. The intervention was documented for the patient.


115 patients that were included in this evaluation, 46 (40%) of patients fell into the fluctuating or poor control group; 21 in the poor control and 25 in fluctuating control. 96% of these patients were willing to meet regularly and 100% of these developed an intervention. The patients reported a positive view of this program.


Using theories of behavioral change, this interdisciplinary intervention showed that patients with poor or fluctuating control of phosphorus were willing to meet and create a plan for change. Belief that poorly controlled phosphorus patients would not care to make changes was disputed by these results. This model actively included the patient as part of the management plan and could be applied to many parts of the hemodialysis treatment to improve adherence to management guidelines.