Effectiveness of a Nutritional Mobile Application for Management of Hyperphosphatemia in Patients on Hemodialysis: A Multicenter Open-Label Randomized Clinical Trial

Abstract

This study aims to determine the effectiveness of a phosphate mobile app (PMA), MyKidneyDiet-Phosphate Tracker ©2019, on hemodialysis (HD) patients with hyperphosphatemia. A multicenter, open-label, randomized controlled trial design allowed randomization of patients with hyperphosphatemia to either the usual care group (UG; receiving a single dietitian-led session with an education booklet) or the PMA group (PG). Thirty-three patients in each intervention group completed the 12-week study. Post-intervention, serum phosphorus levels were reduced in both groups (PG: −0.25 ± 0.42 mmol/L, p = 0.001; UG: −0.23 ± 0.33 mmol/L, p < 0.001) without any treatment difference (p > 0.05). Patients in both groups increased their phosphate knowledge (PG: 2.18 ± 3.40, p = 0.001; UG: 2.50 ± 4.50, p = 0.003), without any treatment difference (p > 0.05). Dietary phosphorus intake of both groups was reduced (PG: −188.1 ± 161.3 mg/d, p < 0.001; UG: −266.0 ± 193.3 mg/d, p < 0.001), without any treatment difference (p > 0.05). The serum calcium levels of patients in the UG group increased significantly (0.09 ± 0.20 mmol/L, p = 0.013) but not for the PG group (−0.03 ± 0.13 mmol/L, p = 0.386), and the treatment difference was significant (p = 0.007). As per phosphate binder adherence, both groups reported a significant increase in Morisky Medication Adherence Scale scores (PG: 1.1 ± 1.2, p < 0.001; UGa: 0.8 ± 1.5, p = 0.007), without any treatment difference (p > 0.05). HD patients with hyperphosphatemia using the PMA achieved reductions in serum phosphorus levels and dietary phosphorus intakes along with improved phosphate knowledge and phosphate binder adherence that were not significantly different from a one-off dietitian intervention. However, binder dose adjustment with meal phosphate content facilitated by the PMA allowed stability of corrected calcium levels, which was not attained by UC patients whose binder dose was fixed.

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

“…There were six reports of feasibility/usability [ 26 , 42 , 44 , 48 , 49 , 52 ], five for self-efficacy [ 40 , 43 , 47 , 49 , 56 ] and acceptability [ 42 , 44 , 49 , 52 , 56 ], and four for health related quality of life (HRQoL) [ 42 , 43 , 47 , 48 ], with positive effects generally reported for these outcomes ( Table 3 ). Similarly, there were three reports on knowledge [ 25 , 40 , 53 ], two for self-management [ 43 , 48 ] and one for disease knowledge [ 55 ] with positive effects reported on these outcomes ( Table 3 ). Seven reported serum phosphorus [ 25 , 42 , 47 , 48 , 52 – 54 ], one serum phosphate [ 40 ], two urine phosphorus [ 50 , 51 ], and another dietary phosphorus intake [ 56 ] ( Table 1 ).…”

“…With most reporting no change ( Table 4 ). Five reported serum albumin [ 26 , 40 , 47 , 52 , 53 ], with another reporting urine albumin [ 50 ], there was no effect on this outcome ( Table 4 ). There were five reports of serum potassium [ 26 , 42 , 47 , 48 , 54 ], one for dietary potassium intake [ 56 ], and one for urine potassium [ 50 ] with the majority reporting a positive effect ( Table 4 ).…”

“…For sodium there were either no change or positive effects reported [ 26 , 50 , 51 , 56 ] ( Table 4 ). Majority of reports were of no change for body mass [ 26 , 43 , 50 , 51 ], circulating lipids [ 43 , 51 , 54 ], and energy and protein intake [ 25 , 50 , 53 , 56 ]. With positive effects reported for blood pressure [ 49 – 51 ] and no change or positive effects reported for intradialytic weight gain [ 42 , 48 , 54 , 56 ].…”

“…( Table 4 ). There were two reports for serum calcium [ 48 , 53 ] and parathyroid hormone [ 48 , 53 ], with reports of positive effects on serum calcium [ 53 ]. A retrospective cohort analysis showed an improvement in their composite outcome of decline in eGFR and incidence of ESKD following the use of a lifestyle application [ 45 ].…”

The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

“…Another research team highlighted the effect of individual health education—conducted by a physician with short-term nutrition training—on hyperphosphatemia and adherence to MNT [ 57 ]. Moreover, a recent clinical trial reported that management of hyperphosphatemia can be achieved through a mobile application (similar to dietitian management), with the additional benefit of titrating phosphate binder doses according to individual meal choice [ 58 ].…”