Pragmatic randomised trial of High Or Standard PHosphAte Targets in End-stage kidney disease

Research summary

Binding of intestinal phosphate in patients with KF has been practiced for more than half a century. Today, 88% of UK dialysis patients require binders to achieve treatment targets. Although dialysis is a life-sustaining therapy, the death rate among UK dialysis patients is very high, with one-year age-adjusted survival of only 88%. Patients receiving maintenance dialysis experience significant physical, emotional, mental and psychological impairments which are reflected in poor Health Related Quality of Life (HRQoL) scores. Dialysis patients value improved QoL more than they do improved survival.

72 renal units across the UK contribute data to the UK renal registry (UKRR), and it is anticipated that PHOSPHATE will be conducted in up to 60 of these units recruiting approximately 2000 UK participants. The PHOSPHATE trial will be embedded in a dialysis trial platform based on the NIHR HTA funded SIMPLIFIED trial of colecalciferol versus standard care. SIMPLIFIED aims to enrol 4,200 UK dialysis patients (current recruitment ~ 2400) from up to 50 UK dialysis centres. The trial is a collaboration with the UK Renal Registry (UKRR) and links all participant records with the UKRR and NHS Digital/SAIL/eDRIS. After enrolment, all outcomes are captured via linkage with the UKRR and routinely collected datasets.

PHOSPHATE will harness all SIMPLIFIED systems. SIMPLIFIED participants will be eligible for co-enrolment in PHOSPHATE and vice versa. We do not consider it likely that there will be interaction between colecalciferol (SIMPLIFIED) and phosphate lowering (PHOSPHATE). Both interventions are prevalent in the target population. Colecalciferol does not influence phosphate concentrations. As both trials will share a unified platform, we will be able to assess any interaction.

Main inclusion criteria

Inclusion Criteria:

  1. Age ≥45 years, or Age ≥18 years with diabetes.
  2. ESKD treated with haemodialysis, or peritoneal dialysis, for at least 3 months.
  3. Prescribed at least one phosphate-lowering medication at any dose.
  4. Able to provide informed consent

Main exclusion criteria

  1. Elective kidney transplantation scheduled.
  2. Concomitant major illness / comorbidity that may result in death in the next 6 months in the view of the treating physician.
  3. Participation in an interventional study that is likely to affect serum phosphate concentration.

Chief investigator

Dr Rona Smith

Contact details

Clinical Trials Coordinator: Mr Maulik Patel 

Telephone: 01223 216809