What Are the Current Limitations of PB Therapy

Patient incompliance with PB prescription is assumed to be a major reason for hyperphosphatemia including inadequate timing of PB intake in relation to the meal, completely neglecting PB intake and taking less than the prescribed amount.

Fixed PB dosing regimens, such as 2 PB pills with each meal, are another problem. This strategy does not take into account the normal day-to-day variations in meal phosphorus content. Our own observations show that dietary iP intake for breakfast, lunch and dinner may vary between 100 and 800 mg iP, and even snacks, which are in many cases not covered by PB medication, may contribute up to 400 mg to daily total iP intake. According to these observations only 30% of meals are covered with an adequate PB dose, with the majority of meals being under-dosed.

Potential short- and long-term side effects, such as hypercalcemia, may limit the total amount of PBs prescribed per day and, finally, economic reasons may affect PB therapy in many countries where budget restrictions for drug prescriptions have been implemented.

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