Grant: Project Grant

High phosphate (P) levels in the blood are almost universally seen among patients with kidney failure who require long-term dialysis. High P levels are thought to predispose these patients to cardiovascular disease and death. For this reason, almost all dialysis recipients receive binders that help lower P levels in the blood in addition to instructions on how to restrict P in their food. Despite the lack of high quality evidence to support this approach, achievement of P control has become a major part of the care delivered to patients who receive chronic dialysis. Although lower serum P may be associated with improved outcomes, modern approaches to P control may not be beneficial to patients and may actually be toxic. We are leading a 9-country trial of 3,600 patients, of whom approximately 2,600 have been recruited to date, who receive dialysis that will determine if more intensive control of P is better than a more liberalized approach. The trial is designed to operate seamlessly within the care that is usually provided to patients who receive dialysis. This trial will help provide patients and those who care for them with much-needed information about whether aggressively lowering P leads to improved survival, better heart health and a better quality of life.