Reduction In Phosphate Levels Research Articles

The Use of GAC (Granular Activated Carbon) and Zeolite as an Adsorbent to Reduce The Concentration of Phosphate in Laundry Wastewater

The growth of the laundry business increases every year along with population growth, however the laundry waste produced is generally thrown straight into the drain and flows into water bodies without prior treatment. The threshold limits for laundry wastewater quality standards for phosphate content, Chemical Oxygen Demand (COD) and Total Suspended Solid (TSS) are 10 mg/L respectively based on East Java Governor Regulation No. 72 of 2013. Disposing of laundry waste directly in large quantities into water bodies can have negative effects on the ecosystem in water bodies and water pollution problems. This research aims to determine the efficiency of using GAC and zeolite adsorbents in reducing phosphatelevels in laundry liquid waste. Based on the impact that can pollute water bodies, it is necessary to process laundry liquid waste. One of the processing methods used is the adsorption method, the adsorption process is carried out using Granular Activated Carbon (GAC) and zeolite with a batch system. This research uses liquid wastewater samples from laundry businesses. The variations used in this research are the adsorbent mass, and contact time. The results obtained from this research include SEM (Scanning Electron Microscopes) test results and the percentage reduction in phosphatelevels using GAC and zeolite adsorbents in batch systems. The research results show that the optimum adsorbent mass is 12 grams of adsorbent mixed with GAC and zeolite with a contact time of 150 minutes with a percentage reduction in phosphate levels of 57.14%. The phosphate values of laundry liquid waste after processing with adsorbent mass, adsorbent composition and optimum contact time are 6.5 mg/L.

Effect of Phytoremediation of Eichornia crassipes (Mart.) Solms and Marsilea crenata C. Persl on Reduction of Phosphate Levels in Laundry Waste

Detergent serves as the most widely used cleaner, one of the ingredients for detergent is phosphate. Excessive phosphate in the waters will cause eutrophication and endanger the aquatic biota in it. Therefore, a solution is needed to reduce phosphate in the waters; one such way is by using Eichornia crassipes (Mart.) Solms and Marsilea crenata C. Presl. The purpose of this study was to determine the effect of plant species and phytoremediation time on phosphate levels in laundry waste. The variables studied were variations in plant species and phytoremediation time. In the plant variety, water hyacinth, water clover, and a combination of the two are used. In the variation of time used 0, 48 and 96 hours. The waste used is waste from a laundry business in Wonokromo, Surabaya. Parameters tested include phosphate, DO, BOD, pH, temperature, and turbidity. The exploration stage is in the form of acclimatisation and range finding tests to determine the concentration of wastewater used in the experimental stage. The results showed that plant species and phytoremediation time affected the decrease in phosphate levels. The correlation between phytoremediation time on parameters of phosphate levels, BOD, and pH will decrease with the duration of phytoremediation, but DO parameters will increase with the duration of phytoremediation.

Effectiveness of iron-based phosphate binders in reduction of hyperphosphataemia in chronic kidney disease patients

Background: Ferric citrate is novel iron-based phosphate-binding drug for management of hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients. Objectives: To evaluate impact of ferric citrate therapy on reduction of phosphate levels and improvement in haematological parameters in CKD stages 3-5. Methods: This analytical, observational study was conducted at Kathmandu Medical College Teaching Hospital from 2020 July-December after ethical clearance using convenience sampling method. Non-dialysis dependent patients at CKD stages 3-5, having hyperphosphataemia (serum phosphate >=4.6mg/dL) and anaemia (serum haemoglobin <12 gm%, transferrin saturation <=30%, ferritin <=300ng/mL) were administered with 2gm twice daily dose of ferric citrate for 12 weeks and evaluated on outcomes in terms of reduction in serum phosphate levels and improvement in haematological parameters as study endpoints. Data were entered in Microsoft Excel and analysed in SPSS v.25. Significance level was set at p <0.05. Results: Of 84 study participants, majority had CKD stage 4 (46, 54.76%). A significant reduction (p <0.001) in mean serum phosphate levels of 6.21 ± 1.062 mg/dL from baseline to 4.89 ± 1.100 mg/dL in 12-weeks was observed. Patients with CKD stages 3, 4, and 5 had mean reduction of 1.67 (p = 0.005), 1.40 (p <0.001), and 1.04 mg/dL (p = 0.002) of serum Phosphate level respectively. Significant (p <0.001) improvements in hemoglobin level, serum iron, ferritin, total iron binding capacity, and transferrin saturation were reported. Conclusion: Ferric citrate is effective and well-tolerated phosphate-binder to improve hyperphosphataemia and iron deficiency anaemia in non-dialysis CKD stage 3, 4, and 5.

The Impact of Phosphorus Management Today on Quality of Life: Patient Perspectives

Patients with kidney failure and early stages of chronic kidney disease often develop hyperphosphatemia, which is associated with negative outcomes. The reduction of phosphate levels is the established clinical practice. However, achieving and maintaining target phosphate levels is challenging, and the current methods of phosphate management lead to poor quality of life (QoL) in patients receiving dialysis, particularly because patients might not receive adequate education on phosphate control. Patients receiving dialysis are advised to maintain stringent dietary restrictions and might experience anxiety and depression due to the constant burden of dietary self-management. The lack of nutritional information on food labels makes adhering to dietary restrictions even more confusing and difficult. Phosphate binders are the only pharmacologic treatment currently indicated for hyperphosphatemia. However, phosphate binders have a limited binding capacity and are difficult to incorporate into patients’ daily routines. Because of the suboptimal efficacy of phosphate binders and the negative impact of dietary restrictions on patient QoL, novel therapies for more effective phosphate control are needed. New treatment options that control phosphate levels would enable patients to eat a more normal, healthy diet and potentially improve their QoL.

MO1034PHOSPHATE EQUIVALENT (PEQ) EDUCATION SYSTEM: AN EFFICIENT SELF-ADJUSTMENT PHOSPHATE BINDER DOSAGE TOOL IN DIALYSIS PATIENTS

Abstract Background and Aims Hyperphosphatemia is common in end-stage renal disease (ESRD) because of impaired renal phosphate excretion and is treated by dietary measures, dialysis techniques and the use of phosphate binder medication. It is one of the most important cardiovascular risk factors for dialysis patients. Our goal was to involve dialysis patients in the achievement of phosphate targets by self-adjusting the dose of Phosphate Binders (PB) on a meal-to-meal basis, according to the individual dietary P intake Method We conducted an interventional prospective single-arm study with a pre-post design. The inclusion criteria were patients with ESRD who had been receiving dialysis for more than three months, with dialysis schedule for four hours per session, three times per week, and who were older than 18 years of age. The primary endpoints of the study were the number of patients who reached the goal of serum phosphate before and after the training program and the weekly mean serum phosphate levels evaluated after the intervention period and compare them with the pre-intervention baseline levels. The secondary end-point was the burden of PB daily. All patients were trained in a self-administer PB program. A self-adjusted PB dose card was developed based on the phosphate food content list published by the National Technical University of Athens. The aim was to allow patients to immediately calculate the iP content of any food they consume easily. Phosphate Equivalent (PEQ) was defined as the weight of phosphorus having the same phosphate impact as a given weight of food. One PEQ corresponded in 100 mg of inorganic phosphorous and to one tablet of PB (one tablet of 800 mg of sevelamer). After 4 weeks (weeks 1-4) of washout from previous phosphate binders, eligible patients with serum phosphorus concentrations ≥ 6 mg/dl were included in the study. All patients received standard dietary phosphate counseling and a fixed dosing regimen of sevelamer PB was prescribed according to KDIGO and dialysis unit protocols for eight weeks (weeks 5-12 – pre-intervention period) In the 13th week, patients were asked to practice the self-administer PB program for eight more weeks. Results A total of 97 patients were screened for the study. 21 patients were excluded. 74 patients completed the study. The percentage of patients with uncontrolled phosphate levels reduced from 56.76% (42 out of 74) to 36.48 % (27 out of 74) in the post-intervention period. Of 9 patients who initially had a serum phosphorus level ≥9 mg/dl, 8 were reverted to phosphorus levels < 6 mg/dl at the end of the PEQ intervention period. There was a significant reduction of phosphate levels (prePEQ 7.42 ± 1.43 mg/dl vs. postPEQ 5.59 ± 1.82 mg/dL, p=0.036) and Ca × P levels (prePEQ: 67.1 ± 11.5 mg2/dL2; postPEQ: 51.9 ± 13.4 mg2/dL2, p=0.021) after patient education. There was a non-significant increase on serum calcium (pre PEQ: 8.13 ± 1.18 mg/dL; post PEQ: 8.56 ± 0.83mg/dL, p=0.515) and iPTH (prePEQ: 411 ± 376 pg/mL; postPEQ: 381 ± 321 pg/mL,p=0.13) Conclusion Our work shows that providing the patients with a relatively simple tool about the use of phosphate binders as PEQ is, we had a positive effect on the dialysis patients’ knowledge about the use of PB, phosphate content of their meals, and increase their sense of the necessity of the treatment and it was proved more effective than the standard fixed dose method. Using the PEQ education system was rewarding in an additional 20% of the patients with previous uncontrolled hyperphosphatemia. The PEQ education system is an efficient self-adjustment phosphate binder dosage tool in dialysis patients in reducing the serum phosphate level in our hemodialysis patients.

Reduksi Kadar Phospat Limbah Cair Rumah Sakit Menggunakan Bakung Putih (Crinum asiaticum Linn.) (Studi Kasus: RSUD dr. Soehadi Prijonegoro Kabupaten Sragen)

RSUD dr. Soehadi Prijonegoro Sragen produces liquid waste containing microorganisms, toxic and radioactive chemicals. The results of the laboratory examination showed that the liquid waste level always exceeded the quality standard, namely the parameter of phosphate. The phosphate level in September 2013 was 4.80 mg / L, while in December 2013 the concentration was 2.60 mg / L, so additional treatment is needed, one of which is phytoremediation using white daffodils (Crinum asiaticum Linn.). This research method is an experimental research design with pre-post Test with Control Group Design where the wastewater will pass through a wet tank containing white lily plants with a residence time of 24 hours/day and a treatment rate of 1100 liters/day. Th research aimed to determine the effect of phytoremediation of white daffodils on the reduction of phosphate levels and the average percentage of its reduction. The results of this study in the ninth and tenth sample collection met the quality standards of 1.99 mg / L and 1.89 mg / L. Phytoremediation of white daffodils (Crinum asiaticum linn.) may reduce phosphate levels by 45.59%.

Efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphataemia in chronic kidney disease in Asturias. FOSFASTUR study

Alterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is Sucroferric Oxyhydroxide (SFO). ObjectiveTo analyse the efficacy and safety of OSF in three cohorts of patients, one with advanced chronic kidney disease not on dialysis (CKD-NoD), another on peritoneal dialysis (PD) and the last on haemodialysis (HD), followed for six months. MethodsA prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. ResultsEighty-five patients were included in the study (62 ± 12 years, 64% male, 34% diabetic), 25 with CKD-NoD, 25 on PD and lastly, 35 on HD. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964 ± 323 mg/day. Overall, serum phosphate levels saw a significant reduction at three months of treatment (19.6%, P < 0.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, or the transferrin and haemoglobin saturation indices, although there was a tendency for the last two to increase. Twelve patients (14%) withdrew from follow-up, ten due to gastrointestinal adverse effects (primarily diarrhoea) and two were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1147 ± 371 mg/day. ConclusionsSFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the three groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1000 mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

Eficacia y seguridad de oxihidróxido sucroférrico en el tratamiento de la hiperfosforemia en la enfermedad renal crónica. Estudio FOSFASTUR

IntroductionAlterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SFO). ObjectiveTo analyse the efficacy and safety of SFO in 3 cohorts of patients, one with advanced CKD not on dialysis, another on peritoneal dialysis and the last on haemodialysis, followed for 6 months. MethodsA prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. ResultsEighty-five patients were included in the study (62±12 years, 64% male, 34% diabetic), 25 with advanced CKD not on dialysis, 25 on peritoneal dialysis and lastly, 35 on haemodialysis. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964±323mg/day. Overall, serum phosphate levels saw a significant reduction at 3 months of treatment (19.6%; P<.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, transferrin saturation index or haemoglobin, although there was a tendency for the last 2 to increase. Twelve patients (14%) withdrew from follow-up, 10 due to gastrointestinal adverse effects (primarily diarrhoea) and 2 were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1,147±371mg/day. ConclusionsSFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the 3 groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1,000mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

Randomized Crossover Trial of Phosphate-binding Medication on Serum Phosphate Levels in Patients With Aortic Stenosis

PurposeAortic stenosis is a common cause of valvular heart disease with no means of prevention. The recognized association between aortic stenosis and serum phosphate raises the possibility of preventing progression of the disorder by using phosphate-binding drugs, but there is uncertainty whether such treatment lowers serum phosphate levels in patients without diagnosed renal failure. This pilot study was conducted to answer this question in patients with aortic stenosis. MethodsA randomized, double-blind, crossover trial of the phosphate-binding drug sevelamer was conducted in 72 patients. Patients were prescribed sevelamer 0.8 g (low-dose), sevelamer 2.4 g (high-dose), and matching placebo, 3 times daily with food; each regimen lasted 6 weeks and was allocated at random. Serum phosphate levels were measured at the end of each treatment period, and within-person levels were compared. FindingsSixty-one patients completed the 3 treatment periods. There was no significant difference in the mean end-treatment phosphate levels across all patients (3.38, 3.36, and 3.31 mg/dL with placebo, low-dose sevelamer, and high-dose sevelamer, respectively). Post hoc analysis showed a reduction in phosphate levels with increasing sevelamer dose in the highest baseline phosphate quartile group; a 0.3 mg/dL reduction (mean, 4.09 mg/dL with placebo, 3.95 mg/dL with low-dose sevelamer, and 3.79 mg/dL with high-dose sevelamer; Ptrend = 0.027). ImplicationsSevelamer had no overall statistically significant effect in lowering serum phosphate levels, but a reduction was observed in patients with phosphate levels in the highest quartile group of the population distribution. This hypothesis-generating result requires confirmation in an independent study. If confirmed, a trial of sevelamer in preventing the progression of aortic stenosis may be justified in patients with high phosphate levels. ISRCTN Registry identifier: ISRCTN17365679.

A service review to assess if innovative intensive phosphate dietary education can help reduce phosphate levels to the recommended range in a hemodialysis population.

Studies suggest that hemodialysis (HD) patients are less likely to adhere to phosphate dietary restriction than to potassium, sodium, or fluid restriction. It is particularly important that dietary education is provided appropriately, consistently, and reinforced regularly to encourage compliance with diet and phosphate-binder regimens. Patient awareness of the consequences of a chronically raised phosphate and its treatment is associated with lower serum phosphate levels. The aim of this study was to assess the impact of a structured educational program on patient knowledge and control of serum phosphate in a maintenance HD population. Thirty-six patients with a phosphate level >1.7 mmol/L for the previous 3 months were assessed. A phosphate knowledge questionnaire was devised by the authors and completed by the patient group. This focused on patient knowledge of dietary sources of phosphate and complications of high phosphate levels. The education program was divided into three modules and was based around diet, phosphate additives, and complications of hyperphosphatemia. Visual aids, oral, and written information were provided to each patient throughout the sessions. Seventeen patients completed the education sessions. The knowledge and food frequency questionnaire were repeated at the end of the modules to assess change. Phosphate levels dropped from an average of 2.12-1.73 mmol/L over the education period with a significance level of P = 0.000481 (significant if P < 0.001). This average falls in line with recommended guidelines. Knowledge questionnaire results improved overall. This education program displayed excellent outcomes with an overall reduction in phosphate levels and an improved phosphate knowledge among our sampled HD population. This education program shows that discovering novel ways of education is crucial to enhancing dietetic practice with renal dietitians best placed to deliver patient specific phosphate education.

Alkalosis and Dialytic Clearance of Phosphate Increases Phosphatase Activity: A Hidden Consequence of Hemodialysis.

BackgroundExtracellular pyrophosphate is a potent endogenous inhibitor of vascular calcification, which is degraded by alkaline phosphatase (ALP) and generated by hydrolysis of ATP via ectonucleotide pyrophosphatase/phosphodiesterase 1 (eNPP1). ALP activity (as routinely measured in clinical practice) represents the maximal activity (in ideal conditions), but not the real activity (in normal or physiological conditions). For the first time, the present study investigated extracellular pyrophosphate metabolism during hemodialysis sessions (including its synthesis via eNPP1 and its degradation via ALP) in physiological conditions.Methods and Findings45 patients in hemodialysis were studied. Physiological ALP activity represents only 4–6% of clinical activity. ALP activity increased post-hemodialysis by 2% under ideal conditions (87.4 ± 3.3 IU/L vs. 89.3 ± 3.6 IU/L) and 48% under physiological conditions (3.5 ± 0.2 IU/L vs. 5.2 ± 0.2 IU/L). Pyrophosphate synthesis by ATP hydrolysis remained unaltered post-hemodialysis. Post-hemodialysis plasma pH (7.45 ± 0.02) significantly increased compared with the pre-dialysis pH (7.26 ± 0.02). The slight variation in pH (~0.2 units) induced a significant increase in ALP activity (9%). Addition of phosphate in post-hemodialysis plasma significantly decreased ALP activity, although this effect was not observed with the addition of urea. Reduction in phosphate levels and increment in pH were significantly associated with an increase in physiological ALP activity post-hemodialysis. A decrease in plasma pyrophosphate levels (3.3 ± 0.3 μmol/L vs. 1.9 ± 0.1 μmol/L) and pyrophosphate/ATP ratio (1.9 ± 0.2 vs. 1.4 ± 0.1) post-hemodialysis was also observed.ConclusionExtraction of uremic toxins, primarily phosphate and hydrogen ions, dramatically increases the ALP activity under physiological conditions. This hitherto unknown consequence of hemodialysis suggests a reinterpretation of the clinical value of this parameter.

PTH signaling mediates perilacunar remodeling during exercise

Mechanical loading and release of endogenous parathyroid hormone (PTH) during exercise facilitate the adaptation of bone. However, it remains unclear how exercise and PTH influence the composition of bone and how exercise and PTH-mediated compositional changes influence the mechanical properties of bone. Thus, the primary purpose of this study was to establish compositional changes within osteocytes' perilacunar region of cortical bone following exercise, and evaluate the influence of endogenous PTH signaling on this perilacunar adaptation. Raman spectroscopy, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) were used to evaluate tissue composition surrounding individual lacuna within the tibia of 19week old male mice exposed to treadmill running for 3weeks. As a result of exercise, tissue within the perilacunar region (within 0–5μm of the lacuna wall) had a lower mineral-to-matrix ratio (MMR) compared to sedentary controls. In addition, exercise also increased the carbonate-to-phosphate ratio (CPR) across both perilacunar and non-perilacunar regions (5–10μm and 10–15μm from the lacuna walls). Tibial post-yield work had a significant negative correlation with perilacunar MMR. Inhibition of PTH activity with PTH(7-34) demonstrated that perilacunar remodeling during exercise was dependent on the cellular response to endogenous PTH. The osteocytes' response to endogenous PTH during exercise was characterized by a significant reduction in SOST expression and significant increase in FGF-23 expression. The potential reduction in phosphate levels due to FGF-23 expression may explain the increase in carbonate substitution. Overall, this is the first study to demonstrate that adaptation in tissue composition is localized around individual osteocytes, may contribute to the changes in whole bone mechanics during exercise, and that PTH signaling during exercise contributes to these adaptations.

The application of high-pressure treatment in the reduction of phosphate levels in breakfast sausages

This study investigated effects of high pressure (HP) treatment of pork meat at 150 or 300MPa for 5min before manufacturing sausages on the reduction of phosphate levels and compared to sausages manufactured with untreated pork meat (control sausages). Improvement in perceived saltiness, juiciness and overall flavour was observed in sausages manufactured using HP-treated meat at 150MPa and 0% phosphate, compared to control sausages. Sausages manufactured using meat HP-treated at 150MPa and 0.25% phosphate (P<0.05) improved hardness of sausages. HP-treated meat at 300MPa and 0% phosphate decreased juiciness and adhesiveness, while at 0.25% phosphate, adversely affected emulsion stability and sensory attributes. HP treatment did not affect significantly the lightness of the sausages; however, elimination of phosphate reduced (P<0.05) the yellowness, while HP treatment at 150MPa with 0.25 or 0.5% phosphate increased (P<0.05) redness. HP reatment at 150MPa has potential for reducing phosphate levels in sausages without significant changes in their functionality and improved acceptability.

Thrice-Weekly In-Center Nocturnal Hemodialysis: An Effective Strategy to Optimize Chronic Dialysis Therapy

Daily nocturnal hemodialysis (NHD) has been proposed as a valuable strategy to improve outcomes for patients on conventional hemodialysis (CHD), but it is burdened by high costs and logistic issues. Thrice NHD might represent a more affordable approach to improve hemodialysis patient outcome. Here we retrospectively analyzed the data on blood pressure, body weight, and hematochemical parameters in a cohort of 7 patients (mean age 50.4-/+11.0 years, duration of CHD 14.3-/+11.5 years) who registered in the NHD program at the dialysis unit of Ospedali Riuniti, Bergamo, Italy. Data for the 2 first years of NHD were compared with those of the last year on CHD. At 2 years after start of NHD, we found a significant decrease in systolic (149.4-/+16.6 vs. 128.4+/-26.0 mm Hg, p<0.001) and diastolic (87.7-/+11.1 vs. 79.6-/+16.7 mm Hg, p<0.05) blood pressure, along with a significant reduction in the use of per-patient antihypertensive agents (1.17-/+1.19 vs. 0.47-/+0.89, p<0.05 and an increase in dry body weight (61.4-/+21.8 vs. 67.1-/+16.4 kg, p<0.001). Moreover, patients had a significant reduction in phosphate levels (6.2-/+2.4 vs. 5.4-/+3.0 mg/dL, p<0.01). The procedure was safe and well tolerated and did not require extra cost for ad hoc facilities. NHD is an effective approach to optimize chronic dialysis therapy.

PHOS GRAPH a novel tool in hyperphosphataemia management in haemodialysis patients

Background: In patients with end stage renal disease, hyperphosphataemia is an almost universal complication. Prolonged hyperphosphataemia is associated with increased morbidity and mortality (Kidney Disease Outcomes Quality Initiative‐K/DOQI, 2004). Pharmacological interventions such as phosphate binders are important in the management of hyperphosphataemia, but these need to be complemented by education regarding binder compliance with phosphate containing foods and limiting excessive phosphate intake. A previous audit carried out in September 2006 of the ‘knowledge of haemodialysis patients on a low phosphate diet and binders’ clearly indicated that we need to improve patients’ knowledge to achieve better control of hyperphosphataemia. The purpose of the study was to assess the effectiveness of an innovative method of patient education (Phos Graph) on the management of serum phosphate in haemodialysis patients with persistent hyperphosphataemia.Methods: The renal dietitians and the renal multi disciplinary team devised a tool called the Phos Graph. The Phos Graph is a novel patient information tool, to inform patients of their phosphate levels relative to their peers on dialysis. The Graph shows the upper limit and lower limit of the normal range, the patient's value for the month as well as their value for the previous month and a rank in comparison to their dialysis peers. Thirty‐four (of 129 patients on haemodialysis) patients with phosphate levels &gt;1.8 mM were identified at the beginning of the study. These patients received a copy of the Phos Graph, an individual dietary assessment and a review of their low phosphate diet by the renal specialist dietitians. This study was carried out for three consecutive months (April to June 2007). The mean serum phosphate levels at the start and finish of the study were compared using the paired student two tailed t‐test. Statistical significance was taken at the P‐value &lt;0.05.Results: Table 1 shows the comparison of phosphate levels for patients who received both, the Phos Graph and dietary intervention and those who received only Phos Graph. Mean phosphate levels during the 3 month study period Phosphate (mM) Start of study End of study P value &gt;1.8 (Phos Graph + dietary intervention) n = 34 2.42 2.16 &lt;0.05 &lt;1.8 (Phos Graph without dietary intervention) n = 95 1.29 1.43 &lt;0.05 Discussion: The study showed that there was a statistically significant reduction in phosphate levels during July 2007 for the 34 patients identified with raised levels in April 2007. However, the mean phosphate level at the end of the study is still above the recommended national level.Conclusion: In this pilot study ‘Phos Graph’ has proved to be a good tool to assist patients in managing hyperphosphataemia. However, it is difficult to distinguish whether it was the Phos Graph or individualized dietary care or both that resulted in improvements in serum phosphate levels. Further work on a larger group is needed to clarify this issue.Acknowledgment: We would like to thank Matthew Jones (Renal systems manager) and also to all Renal staff for their valuable support.References Block et al. (2004) Mineral metabolism, morbidity and mortality in maintenance haemodialysis patients. J. Am. Soc. Nephrol.15, 2208–2218.Kidney Disease Outcomes Quality Initiative (KDOQI). (2002) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease, Guideline 3. Evaluation of Serum Phosphorus Levels.Renal Association. Renal Association Standards Committee. (2002) Treatment of adults and children with renal failure: standards and audit measures, 3rd edn. Royal College of Physicians, London.The UK Renal Registry. (2005) Chapter 10: Bone Biochemistry: Serum Phosphate, Calcium, Parathyroid Hormone, Albumin and Aluminium. 8th Annual Report.