Hi. I’m Dr. Salvatore Chillemi - I’m a nephrologist in clinical practice in the suburbs of Atlanta, Georgia. I have been in practice for over 10 years and currently manage around 86 patients or so on dialysis.

Phosphorus management is one of the most challenging aspects of caring for my patients. We target a phosphorus level of less than 5.2 mg/dL but if I’m being honest, it’s difficult to achieve that target for a number of our patients. We try, but we haven’t been able to get all of our patients on dialysis to our goal of less than 5.2.

I have a number of patients on a binder, often four tablets three times a day with meals, and some on multiple different binders, that still remain unfortunately above our target. When I think about which patients are candidates for additional intervention, I look at all my patients with a phosphorus level of over 5.2. Although we don't typically make changes based on a single lab result, we look at trends over time, often looking back at previous month’s values to decide what action we will take.

It’s exciting that we have XPHOZAH, a phosphate absorption inhibitor, specifically indicated for patients on dialysis to reduce serum phosphorus as add on therapy when a phosphate binder does not work well or when patients are intolerant to any dose of a phosphate binder.

I have prescribed XPHOZAH to a number of patients who have elevated phosphorus levels despite treatment with a phosphate binder. I start with the recommended dose of one 30mg tablet twice a day – one pill just before breakfast or the first meal of the day, and one pill just before dinner. In some patients, I add XPHOZAH to the full binder dose, monitor their labs, and based on their phosphorus levels, sometimes may adjust their binder dose. In other patients, I add XPHOZAH and immediately adjust the binder dose. It just depends on the patient and their phosphorus level.

While every patient is different and our results may vary, our experience with XPHOZAH thus far has been positive. Most of our patients on XPHOZAH have seen a good response. A majority of our patients have had decrease in phosphorus of approximately 1-2 mg/dl. Some have had a greater response, and some have had a lesser response. I’m not sure about the reason for the differences – it just varies for each individual patient.

I’ve had some patients who have complained about diarrhea when taking XPHOZAH, but from what I have seen with my patients, diarrhea has typically resolved within a couple of weeks – either on its own or when we have gone down to a dose of 20 mg BID. We have had a couple of patients that have stopped XPHOZAH because of diarrhea. I always make sure to tell my patients to stop any laxatives or stool softeners when taking XPHOZAH.

When I talk to my patients about starting XPHOZAH, I like to let them know that XPHOZAH works differently than binders. It is also important that they understand it is dosed as 1 pill twice a day, which is different than what they are used to with their phosphate binders. I tell them that first and foremost, the goal is to get their phosphorus down – and if we can also reduce the overall number of pills, that’s a bonus. And that is meaningful to many of my patients.

Overall, my patients are reporting positive experiences on XPHOZAH. In addition to being happy about seeing their phosphorus come down, some have also come down on their overall number of phosphate lowering pills and are quite pleased with that too. I’ve found that in my patients with elevated phosphorus levels on a binder, adding XPHOZAH has helped reduce phosphorus levels and has helped me with my goal of getting more patients to our targets. Thank you!



INDICATION XPHOZAH (tenapanor) 30 mg BID is indicated to reduce serum phosphorus in adults with chronic kidney disease (CKD) on dialysis as add-on therapy in patients who have an inadequate response to phosphate binders or who are intolerant of any dose of phosphate binder therapy.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS XPHOZAH is contraindicated in: • Pediatric patients under 6 years of age • Patients with known or suspected mechanical gastrointestinal obstruction

WARNINGS AND PRECAUTIONS Diarrhea Patients may experience severe diarrhea. Treatment with XPHOZAH should be discontinued in patients who develop severe diarrhea.

MOST COMMON ADVERSE REACTIONS Diarrhea, which occurred in 43-53% of patients, was the only adverse reaction reported in at least 5% of XPHOZAH-treated patients with CKD on dialysis across trials. The majority of diarrhea events in XPHOZAH-treated patients were reported to be mild-to-moderate in severity and resolved over time, or with dose reduction. Diarrhea was typically reported soon after initiation but could occur at any time during treatment with XPHOZAH. Severe diarrhea was reported in 5% of XPHOZAH-treated patients in these trials.