Purpose: Tenapanor (XPHOZAH), approved by the US FDA in October 2023, is indicated to reduce serum phosphorus in adults with chronic kidney disease on dialysis as add-on therapy in patients who have an inadequate response to or are intolerant of any dose of phosphate binders. Unlike phosphate binders, tenapanor inhibits phosphate absorption by reducing permeability through the paracellular pathway. We report results of a real-world survey on patient perspectives of serum phosphate management while receiving tenapanor for hyperphosphatemia.
Patients and methods: Survey invites were distributed via the ArdelyxAssist patient assistance program and survey responses were coupled to pharmacy dispensing data. Eligible participants were patients with hyperphosphatemia on maintenance dialysis receiving tenapanor for at least 7 weeks, last dispensed no more than 12 weeks before the survey.
Results: Among 163 respondents (60% male, median age 60), the median duration of tenapanor use was 133 days. Many patients were unaware of their current serum phosphate levels (39%) or changes since starting tenapanor (57%). Excluding these patients, 74% reported good/very good serum phosphate control and 63% noted improved control. Longer duration of tenapanor use correlated with increased awareness of (P under 0.001) and perceived improvement in phosphate control (P under 0.05). Most patients (71%) reported tenapanor was easy to take. Median prescription fill adherence was 94% and stable over time. Fifty-seven percent of patients reported improved outlook on serum phosphate management, citing better bowel movements (49%), improved serum phosphate control (33%), and reduced pill burden (14%). Patient education questions revealed that 58% of patients received information from non-clinical sources and 20% from nephrologists.
Conclusion: The survey results suggest that patients experience positive outcomes with real-world use of tenapanor, including improved bowel movements, serum phosphate control, and reduced pill burden. These findings highlight the ability of tenapanor to address unmet needs in hyperphosphatemia management.
Keywords: bowel movements; patient perspective; pill burden; serum phosphate control.
Why was the study done?: People with chronic kidney disease who receive dialysis often have high phosphate levels in the blood that are difficult to control. Some patients do not respond well to phosphate binders or cannot tolerate them. Tenapanor is a newer treatment that lowers phosphate in a different way by lowering phosphate absorption from the gut. This study explored patients’ real-world experiences with tenapanor, including their understanding of phosphate levels, ease of use, and effects on daily life.
What did the researchers do and find?: Researchers surveyed patients on dialysis who had taken tenapanor for at least seven weeks and linked survey responses to pharmacy dispensing data. Many patients were unaware of their current phosphate levels or how these had changed since starting treatment. Among those who were aware, most reported good or very good phosphate control, with many noting improvements. Patients who had taken tenapanor longer were more likely to understand their phosphate levels and report improved phosphate control. Most patients found tenapanor easy to take and showed high prescription adherence. Over half reported a more positive outlook on managing phosphate levels, often due to improved bowel movements, better phosphate control, or fewer pills. Many patients received phosphate management information from non-clinical sources.
What do these results mean?: These findings suggest that many patients have positive real-world experiences with tenapanor, including perceived improvements in phosphate control, bowel habits, and pill burden, and highlight the need for better patient education and awareness of phosphate levels.
© 2026 Kendrick et al.