Open Access Highly Accessed Research article

Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis

Maria Tereza Silveira Martins1, Luciana Ferreira Silva2, Angiolina Kraychete3, Dandara Reis4, Lidiane Dias4, Gabriel Schnitman4, Lívia Oliveira4, Gildete Barreto Lopes4 and Antonio Alberto Lopes5*

Author Affiliations

1 Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil

2 Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil

3 Instituto de Nefrologia e Diálise, Salvador, Bahia, Brazil

4 Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Salvador, Bahia, Brazil

5 Departamento de Medicina e Apoio Diagnóstico da Faculdade de Medicina da Bahia, da Universidade Federal da Bahia, Salvador, Bahia, Brazil

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BMC Nephrology 2013, 14:208  doi:10.1186/1471-2369-14-208

Published: 3 October 2013



Despite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence.


A cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire.


Non-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73).


The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.

Hemodialysis; Phosphate binder; Adherence