We know from the Renal Registry reports that overall, only between 60-70% of people on dialysis achieve serum phosphate levels within the recommended range. Therefore, for most units this guideline should provide a prompt to review practice and consider changes to the low clearance clinic and dialysis multi-disciplinary team working. The goal being to achieve better engagement with patients about their diets, so people with advanced CKD or on dialysis have a deeper understanding of what options are available to them.
How is all of this to be paid for? Especially when the guideline emphasises the importance of starting phosphate binders early when they are needed. The economic analysis at NICE suggests that a shift to calcium acetate or calcium carbonate as a first line phosphate binder could pay for the extra dietetic personnel costs many times over by saving upto £3 million pounds per million of the population. Given the variation in practice at unit level, the assumptions used in the audit tools and the costing template provided by NICE. This should help local kidney communities and their commissioners, fine tune the implementation of this guideline and this can lead to achieving more consistent dietetic support for patients, better phosphate control and saving money, which can be reinvested in other aspects of kidney care.