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Abstract: FR-PO150

Effect of Dietary Phosphate, Binder, and Pill Burden on Phosphate Control in Dialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Zamora-Olivencia, Veronica, NorthShore University HealthSystem University of Chicago, Chicago, Illinois, United States
  • Sprague, Stuart M., NorthShore University HealthSystem University of Chicago, Chicago, Illinois, United States

Management of hyperphosphatemia is a major problem in end-stage renal disease (ESRD) with dietary control and phosphate (Phos) binders being the mainstay of therapy. Most ESRD patients require numerous medications, resulting in a high pill burden which may affect adherence and achievement of serum phosphate (sP) levels < 5.5 mg/dL.


A prospective comparative study was performed in 31 chronic dialysis patients. Subjects underwent a baseline evaluation in which they continued their routine binder regimen for 4 weeks, with weekly blood draws. This was followed by a 2 week washout in which all binders were stopped and labs obtained weekly. They were then randomized to either sucroferric oxyhydroxide (SO) or sevelamer (SEV) for 6 weeks, with weekly blood draws except during week 4 when they had daily blood draws. Subjects then underwent a second 2 week washout with weekly labs, followed by 6 weeks with the alternative binder and the same blood draws. Subjects maintained a food diary which was reviewed with a dietician to estimate average daily dietary Phos intake. Total pill burden and achievement of target sP was determined.


Complete data was collected for 24 subjects. Subjects were divided in three dietary Phos groups (n=8): low (334-796 mg/day), medium (821-1129 mg/day) and high (>1140 mg/day). Baseline sP with SEV was 6.21+2.55 mg/dL with a decrease to 5.50+2.40 mg/dL (mean 6 pills/day), whereas with SO baseline sP was 6.20 + 2.50 mg/dL with a decrease to 5.30 + 2.41 mg/dL (mean 4 pills/day). Table demonstrates the pill burden and achievement of target sP while taking SO and SEV stratified by Phos intake.


Comparable number of subjects achieved target sP in both groups. However, SEV resulted in a 50 % higher average pill burden compared to SO. A direct correlation was observed between Phos intake and daily pill burden. Despite increase in binder doses, the percent of subjects that achieved sP < 5.5 was significantly lower in the high Phos diet group compared to the low and medium groups. This suggests that high pill burden may be associated with non-adherence to treatment.

Phosphate Control and Pill Burden Based on Dietary Phosphate
Phosphate DietAvg Pill Burden/DaySubjects with sP < 5.5Avg Pill Burden/DaySubjects with sP < 5.5


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