Date of publication: July 1, 2014

News & Views

Adherence (Part 8) – COMPACT expert view: Dr Stuart Sprague on the importance of low pill burden in the treatment of hyperphosphatemia

In a new video interview for COMPACT, Dr Stuart Sprague from the University of Chicago discusses the optimal approach to phosphate management in dialysis patients. Dr Sprague highlights that effective, tolerable, and low pill burden phosphate binders are key to patient adherence in this highly medicated patient population.



Hello, I’m Dr Stuart Sprague. I’m currently at North Shore University Health Systems and on the faculty at University of Chicago Pritzker School of Medicine.

I’d like to take a few minutes right now and talk to you about the optimal, integrated approach towards phosphate management in dialysis patients.

I’m sure we all realize that regulating serum phosphate is very important for a patient’s optimal health and outcome, and it’s become a very difficult aspect for many patients to do. Generally, the integrated approach toward phosphate management includes:

  • Dietary counselling and the restriction of foods that are high in inorganic phosphates, without excessively restricting protein.
  • The use of adequate dialysis.
  • The appropriate use of medication, such as vitamin D compounds so we don’t enhance phosphate absorption.
  • Appropriate management of parathyroid hormone and adequate dialysis.

However, the mainstay and probably the most important feature of taking care of these patients is that of using phosphate binders.

When we want to approach phosphate binders, we want to make sure that they have low GI side effects, that patients do tolerate them, and that they’re able to take them with their meals, and probably one of the biggest aspects is that of patient compliance and adherence, [which is related to] the number of phosphate binders the patient has to take.

If we consider that many dialysis patients take well over 20 pills a day, and frequently half of those pills are phosphate binders, we then can appreciate how difficult it may be for patients to become compliant or adherent with their phosphate binders, as it becomes difficult to take 2, 3, or 4 pills with each meal, especially these pills that affect the taste of the meal in a negative way.

So therefore, patient adherence and compliance is something that we have to accomplish by using phosphate binders that are effective, tolerable, and require a low pill burden. Having patients having a low pill burden will then enhance their ability to take these binders as prescribed.

See also the previous Adherence articles:

March 24th, 2014; Adherence Part 1 – The challenge of non-adherence in hyperphosphatemia

April 11th, 2014; Adherence Part 2 – Is adherence to phosphate binder therapy associated with improved outcomes?

April 24th, 2014; Adherence Part 3 – Why do patients not adhere to therapies?

May 6th, 2014; Adherence Part 4 – Why do patients not adhere to phosphate binders:poor tolerability?

May 16th, 2014; Adherence Part 5 – Why do patients not adhere to phosphate binders:high pill burden?

May 22nd, 2014; Adherence Part 6 – Improving adherence through treatment optimization and simplifying regimens

June 6th, 2014; Adherence Part 7 – Improving adherence through increased patient education


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