Effectiveness of self-adjusted phosphate binder dose according to dietary phosphate content method in improving hyperphosphatemia among hemodialysis patients

INTRODUCTION: Serum phosphate level control is a major goal in the management of hyperphosphatemia among end stage kidney disease patients. This study aimed to evaluate the effectiveness of self-adjusted phosphate binder dose according to dietary phosphate content method (SPB method) in optimizing the phosphate level among hemodialysis patients.
METHODS: This was a randomized controlled study conducted from September 2015 to October 2016 which involved eight hemodialysis centers in Penang, Malaysia. Ninety-eight hemodialysis patients who had serum phosphate level more than 1.8 mmol/L were recruited and randomly assigned to intervention and standard group. All patients underwent a standard low phosphate counseling. The 49 patients in intervention group underwent an additional counseling on how to adjust the calcium carbonate tablet dose based on their food intake with the help of a booklet. Meanwhile, the calcium carbonate dose was fixed to the meals among the patients in standard group. The change in serum phosphate levels in both groups at baseline, month-3, month-6 and month-9 were recorded.
RESULTS: The phosphate level at baseline for intervention (2.15±0.22 mmol/L) and standard (2.22±0.27 mmol/L) group were not differed significantly (p = 0.19). The intervention group showed significant lower phosphate level compared to standard group (month-3: 1.68±0.43 mmol/L versus 2.10±0.39 mmol/L; month-6: 1.58±0.34 mmol/L versus 2.07±0.38 mmol/L; month-9: 1.54±0.36 mmol/L versus 1.96±0.33 mmol/L; P < 0.001).
DISCUSSION AND CONCLUSION: The SPB method demonstrated significant greater serum phosphate level reduction than the fixed-dose method. This new method in consuming phosphate binder dose should be introduced among the hemodialysis patients.