New strategies to empower patients with chronic kidney disease in phosphorus control (empower-PHOS)

Serum phosphorus (P) control in hemodialysis (HD) remains a major challenge, largely influenced by phosphate binder adherence and patient engagement. Structured educational strategies may enhance self-care and improve clinical outcomes.

To evaluate the effectiveness of a patient-centered educational intervention for phosphorus control in hemodialysis.

Multicenter, prospective, randomized clinical trial including patients with hyperphosphatemia or high binder requirements, allocated to an intervention group (structured education + Empower-PHOS tool) or a control group (standard care). Serum P, binder dose, and adherence (SMAQ) were assessed at baseline and at 3, 6, and 12 months.

Both groups were comparable at baseline. A total of 122 patients from 14 centers were enrolled. The intervention group achieved significant reductions in serum P at 3 months (from 6.1 to 5.4 mg/dl; p < .001) and at 12 months (from 6.2 to 5.2 mg/dl; p = .010), without changes in the number of pills or daily binder dose. Improvements were observed in both adherent and non-adherent patients, with particularly notable reductions among the latter (from 6.4 ± 1.2 to 5.8 ± 1.2 mg/dl; p = .015). Adherence according to SMAQ did not change significantly.

A structured, patient-centered educational intervention improved phosphorus control in hemodialysis, even among patients with low baseline adherence, without increasing the pharmacological burden. These findings support the integration of personalized educational strategies as a key component in the comprehensive management of hyperphosphatemia in routine hemodialysis practice.