Grant: Operating Grant - PA: Inst of Nutrition, Metabolism and Diabetes -Bridge Funding

Patients with kidney failure who require long-term dialysis are at high risk of dying of cardiovascular causes. In such individuals, phosphate levels in the blood tend to be high. These high levels may be damaging to the heart, blood vessels and bone. Patients who have elevated blood phosphate have significantly higher mortality rates compared with those with normal phosphate. However, it is unclear if actively lowering blood phosphate levels leads to better patient outcomes. Almost all dialysis recipients are on medications that bind phosphate contained in the diet. Although useful for lowering phosphate, these drugs have potentially important side-effects, and may adversely impact quality of life. It is unclear if lowering phosphate, and/or targeting specific phosphate levels in the blood improves survival and lowers the risk of cardiovascular events. Despite this, the vast majority of patients who receive dialysis are actively getting treatment to lower their blood phosphate level. We would like to conduct a trial to clarify this issue by answering the following study question: Does targeting a low blood phosphate level (< 1.50 mmol/L) using graded escalation of phosphate binders and usual nutritional counseling improve survival compared with a more liberalized phosphate target (>2.25 mmol/L) using withdrawal of binders and no supplemental nutritional counseling around phosphate intake in patients receiving long-term dialysis? The above research question will require a large trial and will likely need to be done in many centres across several countries. In the current grant application, we are applying for funding to conduct a pilot trial which is a preliminary step to answering our central research question. Our main objective is to see whether a difference of 0.50 mmol/L in serum phosphate can be achieved between patients in the two phosphate treatment arms.