Calcium/phosphate control in renal dialysis patients is complex and multifactorial. Renal multidisciplinary teams collectively hold the skills and knowledge relevant to achieving effective calcium/phosphate management, but largely fail to do so. If we are to improve patient outcomes in this area it is important that we understand issues around compliance, concordance and adherence.

Dietary adjustment and the appropriate use of phosphate binders are integral to achieving better phosphate control. Dietitians are skilled in teaching methods and behaviour change techniques and therefore, the renal dietitian has a central role to play in supporting consistency within the renal multidisciplinary team. The team needs to develop effective methods of advising patients on calcium/phosphate management; exploring the factors that motivate patients to accept advice and understanding their barriers to acceptance and change. Goals for patients need to be individualised, realistic and achievable and the whole renal team needs to set consistent targets.

Effective binding agents which demonstrate benefit to both patient and clinical teams are essential in improving phosphate control and Lanthanum Carbonate holds distinct advantages over Calcium Carbonate. For any phosphate binder to be effective however, the patient needs to take it, so, above all, patients need to be involved and included in their own calcium/phosphate management.