ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: TH-PO168

Associations Between Pill Burden and Kidney Disease Quality of Life (KDQoL) Among Patients on Maintenance Hemodialysis (HD) and the Impact of More Potent Phosphorus Binding Therapy

Session Information

  • CKD-MBD: Targets and Outcomes
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Kalantar-Zadeh, Kamyar, University of California Irvine, Orange, California, United States
  • Ficociello, Linda, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Zhou, Meijiao, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care, Waltham, Massachusetts, United States

Patients who receive maintenance HD therapy have a high pill burden, which has been associated with lower health-related quality of life (HRQoL). We hypothesize that phosphate binder (PB) pill burden is associated with HRQoL in HD patients. Prior studies were conducted before more potent PB with lower pill burdens were frequently used.


This was a cross-sectional study of adult, in-center HD patients from Fresenius Kidney Care (FKC) facilities who filled out KDQoL-SF 36 in 2019, were prescribed PB monotherapy, with pill burden recorded within 30 days prior to/on KDQoL survey completion date (n=17,757). Stratified random sampling was used to select the study cohort (n=500) defined by PB pills/day (≤3, >3 to 6, >6 to 9, >9 to 12, and >12) and matched for age. As a sensitivity analysis, we examined the association between total pill burden (quartiles of total pills/day: ≤13, >13 to 18, >18 to 24, and >24) and KDQoL. Higher scores are indicative of higher quality of life. ANOVA, chi square, linear regression and logistic regression were utilized.


PB pill burden was not significantly associated with KDQoL summary scores but was significantly associated with the bothered by fluid restriction question (Table). Total pill burden was associated with symptoms/problems (score of 84.1 to 78.2 from Q1 to Q4 of total pills), effects of kidney disease (80.0 to 75.6), physical health (41.4 to 36.1) and mental health (54.3 to 51.6), as well as the bothered by fluid restriction question (74.6 to 65.5).


Among HD patients, both higher PB pill burden and total daily pills were associated with higher likelihood to be bothered with fluid restriction. The additional fluid consumption needed to consume pills may need to be examined among patients who struggle with fluid restrictions.


  • Commercial Support –