Table 5.

Strategies to improve control of dietary phosphorus intake and adherence to phosphate binders in ESRD

Patient education	• Introduce education programs, led by nurses or other ancillary healthcare providers, focusing on the:  ◦ physiologic role of phosphate and its presence in different foods  ◦ role of phosphate in ESRD-associated cardiovascular disease  ◦ importance of phosphate binders and their role in lowering serum phosphorus concentrations  ◦ importance of dietary adherence • Involve patients’ families and friends in educational initiatives • Tailor education to patients’ lifestyle, environment, career, ethnicity, cultural background, and socioeconomic status • Educate patients on appropriate food choices and provide training on preparing suitable meals
Patient empowerment	• Introduce initiatives such as the “Phosphate Education Program” which enable patients with hyperphosphatemia to estimate the phosphate content of their meals and adjust their phosphate binder dose accordingly
Improve properties of phosphate binders	• Reduce pill size and burden • Improve palatability • Reduce associated adverse effects • Introduce electronic monitoring devices, which may help patients remember to take their medications and support adherence

Note: Copyright ©2013. ©Covic and Rastogi; licensee BioMed Central Ltd. Reproduced from Covic A, Rastogi A. Hyperphosphatemia in patients with ESRD: assessing the current evidence linking outcomes with treatment adherence. BMC Nephrol. 2013;14(1):153.¹¹

Abbreviation: ESRD, end-stage renal disease.