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

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.