Adherence to phosphate binders in hemodialysis patients: prevalence and determinants

Yoleen P.M. Van Camp, Bernard Vrijens, Ivo Abraham, Bart Van Rompaey, Monique M. Elseviers

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants.

Methods: Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. ‘Being adherent’ was defined as missing <1 total daily dose/week and ‘being totally adherent’ as missing <1 total daily dose/week, every week.

Conclusions: Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.

Results: Mean age of patients was 67 years and 64 % of the sample was male. Over the 2 months, 78 % of the prescribed doses were taken. Every week, about half of patients were adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence.

Original languageEnglish (US)
Pages (from-to)673-679
Number of pages7
JournalJournal of Nephrology
Issue number6
StatePublished - Nov 25 2014


  • Adherence
  • Dialysis
  • Electronic measurement
  • Medication
  • Phosphate binders
  • Phosphatemia

ASJC Scopus subject areas

  • Nephrology


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