Authors (including presenting author) :
Hui PK(1), Leung PH(1), So KH(1), Hau KC(2)
Affiliation :
(1)Department of Pharmacy, Tuen Mun Hospital, (2)Department of Medicine and Geriatrics, Tuen Mun Hospital
Keyword 1: :
Phosphate Binder
Keyword 3: :
Calcium Carbonate
Keyword 4: :
Pharmacist Interventions
Keyword 5: :
Hyperphosphatemia
Keyword 6: :
Financial Savings
Introduction :
Hyperphosphatemia is a prevalent complication in chronic kidney disease. Phosphate binders vary in cost: sevelamer (~HKD 7.5/800mg tablet) while safer in terms of calcium load, imposes a high pill burden (3–6 tablets per meal), contributing to poor adherence, with self-reported non-adherence rates ranging from 15–85.2%. Calcium-based binders are cheaper but underused due to hypercalcemia concerns. Since July 2025, Tuen Mun Hospital implemented a physician-pharmacist collaborative service via telephone review to safely down-titrate sevelamer and switch to calcium carbonate when appropriate, aiming to improve cost-effectiveness without compromising phosphate control.
Objectives :
To evaluate the safety (serum phosphate and adjusted calcium levels) and cost-saving potential of a pharmacist-led collaborative intervention in optimizing phosphate binder therapy among dialysis patients.
Methodology :
A physician-pharmacist collaborative service was launched in TMH to optimize phosphate binder use. Ward pharmacists screened dialysis patients with criteria endorsed by renal specialists: sevelamer with serum phosphate ≤1.4 mmol/L; sevelamer with adjusted-calcium ≤2.3 mmol/L without calcium carbonate; ongoing aluminum hydroxide; or sevelamer in non-dialysis patients/complex cases. Eligible patients received structured telephone consultations by pharmacists assessing adherence, dietary phosphate, and meal patterns. Recommendations (sevelamer down-titration, switch/add calcium carbonate, or aluminum hydroxide discontinuation) were documented in CMS for renal physician review/action at next visit. De-identified data were retrospectively extracted from CDARS. Primary outcomes: changes in serum phosphate, adjusted calcium, and daily binder tablet count from pre-intervention to first post-intervention follow-up. Secondary outcomes: MRCI change, and annual cost savings.
Result & Outcome :
Between Jul to Oct 2025, 25 dialysis patients at TMH received pharmacist-led telephone reviews with complete pre- and post-intervention data (mean age 62.4 years, 64% male; 11 CAPD, 12 hemodialysis, 2 APD). Sevelamer was down-titrated in 14 patients (56%; mean –3 tablets/day, range –1 to –6); calcium carbonate was newly initiated in 5 alongside sevelamer reduction. Serum phosphate remained stable (1.82 ± 0.58 vs 1.72 ± 0.52 mmol/L; mean difference –0.10, 95% CI –0.35 to +0.15, p=0.40). Adjusted calcium increased slightly but non-significantly (2.21 ± 0.12 to 2.28 ± 0.14 mmol/L; +0.073, 95% CI –0.002 to +0.148, p=0.06). Sevelamer dose reduction not correlated to changes in phosphate (rho –0.03, p=0.874) or calcium (rho 0.19, p=0.350). Hospital sevelamer expenditure fell 57% from HKD 474,388 (Apr 2025) to HKD 201,539 (Nov 2025). The collaborative service was safe, improved drug compliance, and yielded substantial cost savings without compromising hyperphosphatemia control.
