Effectiveness of a hierarchical pharmacist management model on reducing hyperphosphatemia in hemodialysis patients in China: a multicenter randomized study

Abstract

The management of hyperphosphatemia is of critical significance given its high prevalence among hemodialysis (HD) patients and its strong association with worse outcomes. Clinical pharmacists can play a crucial role in medication management, but there is a critical shortage. Currently, there is rarely study evaluating how pharmacists in different roles can engage in medication management. The main aim of this study was to evaluate the impact of a pharmacist-led intervention using a hierarchical management model on hyperphosphatemia. A parallel, prospective, randomized, multicenter study was designed including patients at 9 recruited Dialysis Centers whose serum phosphate (sP) > 4.5 mg/dL with maintenance HD. Every Dialysis Center was allocated one pharmcist, primary management pharmacists (PMP) or senior management pharmacists (SMP), who was responsible for education. After 6-month study, the sP in the intervention group decreased from 6.36 ± 1.30 mg/dL to 5.55 ± 1.34 mg/dL, and was much lower than control group (6.02 ± 1.53 mg/dL) (p < 0.05). But the nutritional indicators, such as albumin and hemoglobin hadn’t been affected (p > 0.05). Importantly, both PMPs and SMPs achieved clinically meaningful reductions in sP (p < 0.05 for both within-group comparisons), with no statistically significant difference between the two groups (p = 0.11). These findings suggest that a hierarchical pharmacist management model—combining standardized education with targeted SMP support for high-risk patients—can enable PMPs to deliver care comparable to that of SMPs. This approach may help optimize limited pharmacy resources and expand access to high-quality medication management for hemodialysis patients with hyperphosphatemia.