Grant: Project Grant

High phosphate levels in the blood are almost universally seen among patients with chronic kidney failure who require dialysis. These high phosphate levels are thought to predispose patients to cardiovascular disease and death. For this reason, almost all dialysis recipients receive tablets called phosphate binders that help lower phosphate levels in the blood. In Canada, the most common binder is calcium which is taken with meals and attaches to phosphate in the intestine and prevents the absorption of phosphate. Despite the lack of high quality evidence to support this approach, achievement of phosphate control has become entrenched in the care administered to chronic dialysis recipients. Although lower serum phosphate may be associated with improved clinical outcomes, modern approaches to phosphate 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 phosphate lowering will have a profound effect on the care provided to contemporary dialysis patients.