Simplified Phosphate Binder Pill Regimen Could Improve Health

Hemodialysis patients often have many health problems in addition to their kidney disease. They are often prescribed many oral medications, including phosphate binders, contributing to a high “pill burden.”

New research from the Dialysis Outcomes and Practice Patterns Study (DOPPS) examines data on pill burden, whether patients reported that they were taking their prescribed phosphate binder pills, and measurements of serum phosphorus and parathyroid hormone levels in patients. The study, published in Hemodialysis International, included data collected from 5,262 in-center hemodialysis patients from units participating in the DOPPS in 12 countries.

Researchers found that the number of phosphate binder pills prescribed to patients varied across countries: hemodialysis patients in the US are prescribed about seven and a half pills per day while hemodialysis patients in France are prescribed about four pills per day. Overall, the authors found that the patients who were more likely not to follow their doctors’ prescriptions were the ones who were prescribed the most pills. Dr. Rachel Fissell, the lead author of this study, noted “our team was surprised by the high number of times patients reported they were skipping their phosphate binders.” Not following doctors’ prescriptions was associated with high serum phosphorus and parathyroid hormone levels, which are associated with poor health outcomes.

Adherence to phosphate binders is a challenge for many hemodialysis patients and may be related to the number of pills prescribed. Commenting on the implications of this study, Dr. Fissell concluded, “Prescription of a simplified phosphate binder regimen could improve patient adherence and perhaps improve serum phosphate and parathyroid hormone levels.”

CITATION:
Fissell RB, Karaboyas A, Bieber BA, Sen A, Li Y, Lopes AA, Akiba T, Bommer J, Ethier J, Jadoul M, Pisoni RL, Robinson BM, Tentori F. Phosphate binder pill burden, patient-reported non-adherence, and mineral bone disorder markers: Findings from the DOPPS. Hemodial Int. 2015 May 14. doi: 10.1111/hdi.12315. [Epub ahead of print]