Effects of education on low-phosphate diet and phosphate binder intake to control serum phosphate among maintenance hemodialysis patients: A randomized controlled trial

Abstract

BackgroundFor phosphate control, patient education is essential due to the limited clearance of phosphate by dialysis. However, well-designed randomized controlled trials about dietary and phosphate binder education have been scarce.MethodsWe enrolled maintenance hemodialysis patients and randomized them into an education group (n = 48) or a control group (n = 22). We assessed the patients’ drug compliance and their knowledge about the phosphate binder using a questionnaire.ResultsThe primary goal was to increase the number of patients who reached a calcium-phosphorus product of lower than 55. In the education group, 36 (75.0%) patients achieved the primary goal, as compared with 16 (72.7%) in the control group (P = 0.430). The education increased the proportion of patients who properly took the phosphate binder (22.9% vs. 3.5%, P = 0.087), but not to statistical significance. Education did not affect the amount of dietary phosphate intake per body weight (education vs. control: −1.18 ± 3.54 vs. −0.88 ± 2.04 mg/kg, P = 0.851). However, the dietary phosphate-to-protein ratio tended to be lower in the education group (−0.64 ± 2.04 vs. 0.65 ± 3.55, P = 0.193). The education on phosphate restriction affected neither the Patient-Generated Subjective Global Assessment score (0.17 ± 4.58 vs. −0.86 ± 3.86, P = 0.363) nor the level of dietary protein intake (−0.03 ± 0.33 vs. −0.09 ± 0.18, P = 0.569).ConclusionEducation did not affect the calcium-phosphate product. Education on the proper timing of phosphate binder intake and the dietary phosphate-to-protein ratio showed marginal efficacy.

Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia

“…Similar to our findings, previous studies have reported better knowledge does not always translate to a better serum phosphate level [ 11 , 22 , 65 , 66 , 67 ]. With the growing body of evidence that educating hemodialysis patients on phosphorus improved serum phosphate levels [ 68 , 69 , 70 , 71 ], it is incumbent upon the healthcare professional community to acknowledge that education programs are indispensable for the optimal management of hemodialysis patients in routine care [ 72 ]. On the other hand, it would be appropriate to consider the application of more interactive approaches or technologies such as the internet and mobile telephones as education tools to extend support beyond the hospital setting, and enhancing accessibility to information aims to improve patients’ self-care management [ 66 ].…”

Phosphate binders usage, patients knowledge, and adherence

“…21,22 The level of knowledge reported by our study was similar to what has been reported previously. 19 The possible reasons for patients' superficial knowledge on phosphate dietary control and phosphate binders include patients' difficulty in understanding the complexity of the role of minerals and electrolytes, and their interactions in the body. Additionally, the availability of media information regarding phosphate binders is lacking.…”

What is the Level of Awareness About the Foods Containing Inorganic Phosphorus in Patients with Chronic Renal Failure?

“…They found no difference in calcium-phosphate products after the education. 11 This may be attributed to patients' lack of discipline over their diet or fatigue with long-term treatment programs.…”