Patient education for hyperphosphatemia management: Improving outcomes while decreasing costs?

modialysis patients, behavioral changes associated with the management of hyperphosphatemia, such as the adoption of a low phosphate diet and judicious intake of phosphate binders, are probably the most complicated and challenging [1,2]. Non-adherence to low phosphate diets, which are likely the most common dietary restrictions required from this patient population, ranges between 19 and 57% [3,4]. Likewise, non-adherence to phosphate binders is common, ranging between 22 and 74%, with more than half of hemodialysis patients not following their prescribed regimens [5]. In line with this background, it is unsurprising that more than a decade after the first international clinical practice guidelines for chronic kidney disease-mineral bone disorder were issued [6], a wide gap persists between recommended and measured serum phosphorus levels among hemodialysis patients in clinical practice. Hyperphosphatemia is the most common mineral abnormality among this patient population, with nearly one in two hemodialysis patients being hyperphosphatemic [3]. While the pharmaceutical industry has responded by developing new agents, little importance has been given to patient education programs, specifically counseling to foster behavioral changes, in clinical practice, despite mounting high-quality evidence regarding the effectiveness of this intervention [7]. In this issue of Kidney Research and Clinical Practice, Lim et al [8] assessed the impacts of nutrition and pharmacologic education on serum phosphate, calciumphosphate product, and adherence to a low phosphate diet, i.e., dietary phosphate intake and phosphorus-toprotein ratio, self-reported compliance with phosphate binder prescriptions, prescribed bioequivalent dose of binders and knowledge regarding proper intake timing, as well as nutritional status, among other parameters. After random assignment to experimental groups, 48 patients received one 30-minute individualized educational session with a dietitian and another session with a pharmacist, while the control group received conventional care without education sessions. The investigators explored changes over the short (one-month post-education) and long-term (two or three months post-education). The authors reported no significant changes in any of the study parameters between the intervention and the control groups, either over the shortor long-term. The absence of any effect associated with patient education intervention could be partly explained by the study limitations acknowledged by the authors, specifically, the baseline parameters of the sample. More than two-thirds of the study sample had good phosphate control, and mean baseline serum phosphate levels that were within the recommended range according to international renal guidelines [6]; moreover, the mean baseline compliPatient education for hyperphosphatemia management: Improving outcomes while decreasing costs? Mirey Karavetian, Rana Rizk Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-LB), Faculty of Public Health, The Lebanese University, Fanar, Lebanon Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands Editorial