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Liquid Sevelamer Pill Burden Solution — ESENeph MCQ

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EasyHaemodialysisLiquid Sevelamer Pill Burden SolutionESENeph

A 47-year-old man with ESKD on haemodialysis has persistent hyperphosphataemia despite maximal medical management. He is not transplant-listed. His nutritional status is poor, with albumin 28 g/L and BMI 19 kg/m2. He reports difficulty swallowing his phosphate binders. What practical intervention may improve his phosphate binder adherence?

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Correct answer: B — Switch to liquid sevelamer suspension

Pill burden is a major barrier to phosphate binder adherence. Sevelamer is available as a powder/suspension formulation that can be mixed with water or food, avoiding the need to swallow multiple large tablets. For patients with dysphagia or swallowing difficulties, this liquid formulation significantly improves adherence. Importantly, phosphate binders MUST be taken WITH meals to bind dietary phosphate in the gut — taking them between meals provides no benefit. Crushing enteric-coated or modified-release preparations may alter drug properties. Sucroferric oxyhydroxide (Velphoro) has chewable tablets with a lower daily pill count, which is another alternative approach for reducing pill burden.

Reference: KDIGO 2024 – CKD-MBD; UKKA 2015 – CKD-MBD; Chiu et al 2009 – Phosphate Binder Adherence