Bhargava R, et al. - In the SPIRiT (Serum Phosphate Intervention in Renal Replacement Therapy) study, researchers assessed the subject acceptance, recruitment and retention rates for such a study in which dialysis subjects were randomised to two distinct serum phosphate concentrations, then titrated and maintained over 12 months. Participants were 104 hemodialysis subjects randomized to lower range, Lower Range Group (LRG; 0.8–1.4 mmol/L or 2.5–4.3 mg/dL) and higher range, Higher Range Group (HRG; 1.8–2.4 mmol/L or 5.6–7.4 mg/dL) serum phosphate groups at two centers, with 2 months’ titration and 10 months’ maintenance phase. Non-calcium phosphate binders, self-help questionnaires, with blood tests at specified time intervals were also used as interventions. Over 10 months, the achievement, as well as maintenance of a mean separation by serum phosphate of 1.1 mg/dL, was noted between the groups. Findings revealed 27% of drop-out rate and mortality was 10%. Death of 9 subjects in the HRG (17.6%) and 2 subjects in the LRG (3.8%) was reported. Overall, a clinically significant sustained separation over 12 months could be achieved by randomizing dialysis subjects to separate treatment targets for serum phosphate.