Assessment of Treatment Pattern for Management of Hyperphosphatemia in Maintenance Hemodialysis Patients: A Prospective Observational Comparative Study

Abstract

Background: Hyperphosphatemia is a common complication of End-Stage Renal Disease (ESRD) associated with fluctuating serum levels of phosphorus, calcium, para thyroid hormone (PTH), and metastatic calcification. Based on the calcium-phosphorus level, patients may receive Calcium free or calcium-based drugs with phosphorus restricted diet. Objective: To assess the treatment modalities for the management of hyperphosphatemia. Methodology: A Prospective-observational-comparative-multivariate study, conducted in a tertiary care teaching hospital located in Ernakulam district of Kerala, in India for a period of 6 months. All patients admitted for Hemodialysis(HD) with ESRD and those aged  above 35 were included in the study based on pilot study. Baseline data were obtained at the study entry by utilizing a semi-structured questionnaire, followed by the laboratory values of phosphorus, calcium, inter dialytic weight gain (IDW), medications, etc. from their treatment record. The patient's adherence behaviour was evaluated by using the international disease-specific ESRD adherence questionnaire. Results: Data from 53 cases indicates that, treatment given for management of hyperphosphatemia was not rational, not based on serum levels of calcium and phosphorus. The majority of the population prescribed with calcium-free phosphate binder-sevelamer and only 28% of the population is having controlled serum calcium and phosphorus levels. Poor economic status, a major factor contributing to the low adherence to the medications. Conclusion: Socio-demographic factors statistically do not influence treatment patterns, but annual income correlates with poor drug adherence. For the management of hyperphosphatemia, sevelamer, and calcium-based calcium carbonate and/or calcium acetate were prescribed in this study population. Poor adherence to the diet was found to be the main cofounding factor for hyperphosphatemia.