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Abstract: PO0367

The True State of Hyperphosphatemia Management in Dialysis

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Hurtado, Tucker Bittel, Spherix Global Insights, Exton, Pennsylvania, United States
  • Robinson, Jennifer, Spherix Global Insights, Exton, Pennsylvania, United States

Group or Team Name

  • Spherix Advanced Analytics Group

Hyperphosphatemia affects more than 80% of US dialysis patients and has been shown to have a direct link to increased morbidity and mortality. The objective of this study was to assess the current management of hyperphosphatemia in US dialysis patients and the ability to consistently control serum phosphorus over a six-month period.


Patient level data was collected via an online, HIPAA-compliant form in June 2019 as part of an independent chart audit. A total of 1,015 patient records (789 in-center HD, 200 PD, and 26 home HD) were submitted by 159 nephrologists. Patients had been on dialysis for at least six months (Mean: 26, Median: 15) and most were in LDO-affiliated units.


Patients in the consistently high group had been on dialysis longer than those consistently in target or in the target-high variability group (36 months vs. 23 months) and were also younger on average (53 years vs. 61 years). Those in the consistently high and high-target group (CH/HT) had a 37% higher daily pill burden (from binders) than those consistently in target. Patients dialyzing in Fresenius units were the most likely to be consistently in target (27%). Compared to those consistently in target, those in the CH/HT group were significantly more likely to have diabetes, obesity, heart failure and coronary artery disease. They were also six times as likely to have poorly controlled hypertension. Ethnicity also was correlated with phosphate control with a disproportionate percent of non-white patients in the consistently high and high-target variability groups.


Not only is hyperphosphatemia rampant at any given time, but only a small minority of patients on phosphate binders (19%) are able to achieve consistent control; most patients fluctuate in and out of target. Increased phosphate binder dosing was not associated with better control and suggests that a new approach to the management of hyperphosphatemia is warranted.