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

INTRODUCTION

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.

OBJECTIVE

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

MATERIAL AND

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.