Dialysis patients who believe their healthcare providers support their self-care choices and actions may better adhere to phosphate binder medication, a new study suggests.

Kerri L. Cavanaugh, MD, and Ebele M. Umeukeje, MD, of Vanderbilt University Medical Center in Nashville, and colleagues asked 377 patients on hemodialysis or peritoneal dialysis to complete questionnaires on autonomy support (Health Care Climate Questionnaire) and phosphate binder adherence. They then compared patients’ scores with actual serum phosphorus levels to see whether they correlated.

The climate questionnaire asks patients the degree to which they agree that the healthcare provider:

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  •       provides choices and options,
  •       understands their point of view,
  •       allows them to be open,
  •       conveys confidence in their ability to make changes,
  •       and accepts them personally regardless of their ultimate health care decisions.

In addition, the healthcare provider informs patients of behaviors that compromise their health without pressuring them to change and encourages them to ask questions.

According to results published online in the Journal of Behavioral Medicine, patients who scored higher on the climate questionnaire had greater phosphate binder adherence.  A higher medication adherence score, in turn, was associated with better phosphorus control. The researchers found no direct link between climate questionnaire scores and serum phosphorus levels, however. Serum phosphorus levels vary and are influenced by dialysis and diet.

The investigators further observed that non-white patients reported lower scores on the climate questionnaire, whereas gender exerted no influence. “Patient autonomy may be critically influential in medication adherence among patients with end-stage renal disease,” Dr Cavanaugh told Renal & Urology News. “Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.”

Previous studies on other chronic conditions have revealed benefits from motivational interviewing techniques. Along with other behavioral interventions, it may improve patient empowerment, the investigators suggested.


1. Umeukeje EM, Merighi JR, Browne T, et al. Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease. J Behav Med. [Epub ahead of print]. doi: 10.1007/s10865-016-9745-7.