Phosphate-control adherence in hemodialysis patients: current perspectives

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Pharmacy

Background:

• Hyperphosphatemia in dialysis patients is a significant risk factor for mortality.
• Effective management requires a combination of phosphate binders, dietary phosphorus restriction, and dialysis.
• Current adherence rates to these phosphate-control strategies are suboptimal.

Purpose of the Study:

• To review factors influencing adherence to phosphate-control strategies in dialysis patients.
• To discuss interventions for overcoming challenges in phosphate management adherence.
• To identify patient subgroups at higher risk for nonadherence.

Main Methods:

• Literature search using keywords: phosphorus, phosphorus control, hemodialysis, phosphate binder medications, phosphorus diet, adherence, nonadherence.
• Databases searched include PubMed, PsycInfo, CINAHL, and Embase.
• Review of identified literature to synthesize findings on adherence factors and interventions.

Main Results:

• Phosphate binder therapy offers a survival benefit and is crucial alongside dietary and dialysis interventions.
• Dietary restriction is complex due to protein needs and insufficient alone.
• Hemodialysis alone is insufficient for phosphorus control.
• Adherence is influenced by patient, provider, and strategy-related factors, with psychosocial elements and self-motivation playing key roles.
• Younger and non-white dialysis patients are at higher risk for nonadherence.
• Provider attitudes may significantly impact patient adherence.

Conclusions:

• Multicomponent strategies addressing therapy side effects, patient self-motivation, and provider attitudes are most promising.
• Culturally sensitive care delivery and improved provider attitudes are essential.
• Identifying high-risk patients and implementing flexible, person-centered strategies are critical for long-term phosphorus control.
• Dedicated resources and training are needed to support individualized patient care.