Reducing hyperphosphatemia in dialysis patients with renal-specific oral nutritional supplements

• Dialysis alone cannot eliminate the excess phosphorus in dialysis patients. • Phosphate binders increase the total daily pill load significantly. • Oral nutritional supplements might be suitable replacement for high phosphorus meal. Hyperphosphatemia is a common issue in dialysis patients and a significant risk factor for mineral bone disorders, cardiovascular complications, and mortality. Various therapeutic modalities are available for managing high serum phosphorus, though their effectiveness remains limited. A combination of adequate dialysis, dietary restrictions on phosphorus intake, and phosphate binder therapy are routinely employed in the treatment. However, patient adherence to dietary recommendations and phosphate-binder therapy is often unsatisfactory. This paper proposes replacing phosphorus-rich meals with renal-specific oral nutritional supplements (RS-ONS). Specifically, RS-ONS with low phosphorus content should be used, which allows its use without the need for phosphate binders and with minimal fluid contribution. This approach could lower serum phosphorus levels, decrease the phosphate-binders pill burden, and improve patient compliance and quality of life.