Grant: Operating Grant

High phosphate (P) levels in the blood are almost universally seen among patients with chronic kidney failure who require dialysis. These high P levels are thought to predispose patients to cardiovascular disease and death. For this reason, almost all dialysis recipients receive binders that help lower P levels in the blood. In Canada, the most common P binder is calcium which is taken with meals and attaches to P in the intestine and prevents the absorption of P. Despite the lack of high quality evidence to support this approach, achievement of P control has become entrenched in the care administered to chronic dialysis recipients. Although lower serum P may be associated with improved clinical outcomes, modern approaches to P control may be ineffective at modifying clinically relevant outcomes such as death and cardiovascular events and more ominously, may be toxic. For these reasons, a definitive trial that tests the impact of P lowering will have a profound effect on the care provided to contemporary dialysis patients. This proposed pilot trial is a first step towards performing a definitive trial that may help shape patient care for dialysis recipients.