How do you approach the management of persistent hyperphosphatemia in ESKD patients who are non-adherent to phosphate binders?

This is not easy. The first thing I usually do is try and find out why they are non-adherent. Is it due to side effects, cost, etc? Are there social reasons? For example, are they "embarrassed" to take binders if they are out eating with friends?

Often, I find that I need to switch binders to see if...